Amyloidosis of the Urinary Bladder

Abstract

AMYLOIDOSIS is characterised by deposition, in various tissues, of a homogeneous, eosinophilic, hyaline material. Presently, most cases occur in a generalised form as a manifestation of an underlying plasma cell neoplasm (myeloma) or plasmacytic dyscrasia. On the other hand, most cases of symptomatic amyloid disease in the urinary bladder have occurred as an apparently solitary, localised tumefactive process. The lower urinary tract lesions of the disseminated form of the disease are rarely, if ever, symptomatic.In the detailed review of the literature by Kinzel, Harrison, and Utz in 1961, 5 new cases were reported. Since then, 4 new cases have been seen at the Mayo Clinic. These new cases, additional follow-up information on the previous 5 cases (Kinzel et al., 1961), and a detailed analysis of data pertaining to these and 33 cases reported by others, in which adequate data were available, form the bases of this report. Four more cases only .briefly mentioned by Tripathi and Desautels (1969) without sufficient data are not included in this report. REPORT OF CASESCase 1.-An 80-year-old woman with a history of urosepsis and interstitial cystitis-treated successfully at the Mayo Clinic in 1937 followed in 1965 (28 years later) by transurethral resection and fulguration of bladder lesions elsewhere for recurrent haematuria and dysuria-was again referred to us for further treatment. Her medical evaluation, results of routine blood tests, and excretory urogram were essentially normal. Urinalysis revealed microhzmaturia, pyuria, and mild proteinuria (negative for Bence Jones protein), and urine culture grew significant colonies of Aerobacter rerogenes.Cystoscopy revealed a '' smooth rounded mass several centimeters in diameter on the right side of the dome of the bladder and two masses, each 1 cm. in diameter, on the bladder side of the vesical neck at the 3 o'clock position ".These were biopsied and electrocoagulated, with a subsequent favourable response. The biopsy specimen revealed aggregates of amyloid involving the bladder muscle and blood vessels. Bone marrow biopsy and serum electrophoresis both gave normal results. A year later she underwent bilateral ureterosigmoidostomy for recurrence of her symptoms and a markedly contracted bladder with a trigonal lesion. The lesion proved to be a poorly differentiated (grade 3) infiltrating transitional cell carcinoma with squamous metaplasia. The patient died shortly thereafter from heart disease.Case 2.-A 40-year-old man with a history of vesical irritation, of 3 years' duration, suggestive of interstitial cystitis was examined at the Mayo Clinic in 1952; urological investigations were negative. He remained asymptomatic for 1 I years but returned in 1963 because of a bout of painless gross hzmaturia. The results of routine tests of blood and urine were normal, the urine culture was negative, and the excretory urogram was normal. Cystoscopy revealed a vesical diverticulum on the right side with an adjacent, elevated, reddened, irregular, malignant-appearing area which wa...

Localized amyloidosis of the ureter: a case report

“…One of these is localized nodular amyloidosis, in which nodular amyloid deposits are found in the respiratory tract, gastrointestinal tract, and urinary tract. Although the definitive diagnosis of localized amyloidosis requires confirmation of the absence of amyloid deposits in other organs, Malek et al suggest that no further search is necessary unless secondary amyloidosis is ruled out, Bence-Jones protein is negative, serum protein fraction is normal, and rectal biopsy shows no abnormalities [ 1 ].…”

“…The definitive diagnosis of localized amyloidosis requires confirmation of the absence of amyloid deposits in other organs. Malek et al showed no further search is considered necessary unless secondary amyloidosis is ruled out including Bence-Jones protein, serum protein fraction, and a rectal biopsy [ 1 ].…”

“…The prognosis for localized focal amyloidosis is generally positive. Focal amyloidosis represents a mere 2.8% of all amyloidosis cases and is exceedingly rare in the ureter [ 1 – 3 ]. Here, we present a case report of primary amyloidosis affecting the ureter.…”

Benign Diseases of the Bladder

“…[122][123][124] AMYLOIDOSIS Amyloidosis may be primary to the bladder or secondarily involve the bladder as part of a systemic process. [125][126][127][128] Patients most commonly present with hematuria and irritative bladder symptoms, although a subset of patients may be detected incidentally on work-up for other processes.…”