Bladder leiomyoma presenting as dyspareunia

Abstract

Introduction:Leiomyoma of the bladder is a rare tumor arising from the submucosa. Most patients with bladder leiomyoma may present with urinary frequency or obstructive urinary symptoms. However, there are a few cases of bladder leiomyoma coexisting with uterine leiomyoma presenting as dyspareunia. We herein report an unusual case of coexisting bladder leiomyoma and uterine leiomyoma presenting as dyspareunia.Case presentation:A 44-year-old Asian female presented to urologist and complained that she had experienced dyspareunia over the preceding several months. A pelvic ultrasonography revealed a mass lesion located in the trigone of urinary bladder. The mass lesion was confirmed on contrast-enhanced computed tomography (CT). The CT scan also revealed a lobulated and enlarged uterus consistent with uterine leiomyoma. Then, the biopsies were then taken with a transurethral resection (TUR) loop and these biopsies showed a benign proliferation of smooth muscle in a connective tissue stroma suggestive of bladder leiomyoma. An open local excision of bladder leiomyoma and hysteromyomectomy were performed successfully. Histological examination confirmed bladder leiomyoma coexisting with uterine leiomyoma.Conclusion:This case highlights a rare presentation of bladder leiomyoma, dyspareunia, as the chief symptom in a patient who had coexisting uterine leiomyoma. Bladder leiomyomas coexisting with uterine leiomyomas are rare and can present with a wide spectrum of complaints including without symptoms, irritative symptoms, obstructive symptoms, or even dyspareunia.

The Rare Togetherness of Bladder Leiomyoma and Neurofibromatosis

“…Neurofibromatosis was first described by Von Recklinghausen and the diagnosis requires the presence of at least two of the clinical symptoms in the Table 1 [4]. Leiomyoma is a mesenchymal benign tumor of the bladder that is rare [5]. Bladder wall involvement of neurofibromatosis is rare and there are about 60 case reports in the literature.…”

Bladder leiomyoma

“…Leiomyoma is a benign smooth muscle tumor that can occur in any organ. [ 5 ] In the urinary system, the location is more frequent in the bladder, being the most common benign mesenchymal tumor of this organ. Nonetheless, they only represent <0.5% of all bladder cancers.…”

“…The literature describes rare cases with distinct clinical presentation, as dyspareunia. [ 4 5 ] For diagnosis, cystoscopy and ultrasound examinations are the most frequently performed. Treatment consists of surgical removal of the tumor, and the prognosis is excellent.…”

Leiomioma vesical de crecimiento extramural: Una presentación infrecuente – reporte de caso

“…5,6 Los Leiomiomas de vejiga fueron descritos por primera vez en 1870 por Jackson y solo existen aproximadamente 200 casos publicados en la literatura. 7,8 En la vejiga, los leiomiomas son los tumores benignos mesenquimales más frecuentes, encontrándose en un 46,6% seguido por los hemangiomas en un 26,4% y otros tumores entre los que se incluyen fibromas, rabdomiomas, xantomas, dermoides, osteomas y mioblastomas de células granulosas. 2 A diferencia de la mayoría de los tumores de vejiga, que se originan en el músculo liso.…”

“…5,13,14 Se han descrito la presencia de receptores para estrógenos en los leiomiomas vesicales, razón por la cual se asociaría la influencia de los estrógenos con el crecimiento de los leiomiomas y su infrecuente aparición antes de la pubertad, su mayor incidencia entre la cuarta y quinta década donde las hormonas se encuentran sustancialmente activas, y la disminución del tamaño tumoral posterior a la menopausia. 5,8 En cuanto al tratamiento de los leiomiomas, es posible determinarlo de acuerdo al tamaño, localización anatómica y compromiso de estructuras adyacentes como esfínter o meatos ureterales. 1,7 La resección transuretral y cirugía abierta se han reportado y comparado en estudios previos; Vargas y Méndez han recomendado la resección transuretral como manejo definitivo.…”