Painless Hematuria Research Articles

EGFR EXPRESSION IN PRIMARY EPITHELIAL URINARY BLADDER TUMORS AND ITS CORRELATION WITH CLINICOPATHOLOGICAL PARAMETERS

Introduction: EGFR is over expressed in many epithelial tumors including urothelial carcinomas. Over expression of EGFR is considered as a poor prognostic marker in various studies. Thus, the present study was done to evaluate the EGFR expression in primary urothelial carcinomas and its correlation with clinicopathological parameters. Methods: This was a cross-sectional, observational study carried out between June 1, 2019 to May 31, 2020 in the Department of Pathology and Urology, Indira Gandhi Medical College, Shimla. One hundred and ninety seven patients with primary epithelial urinary bladder cancer were included. Patients with inammatory and metastatic lesions of urinary bladder and post chemoradiotherapy were excluded. The correlation between EGFR expression and the various factors like age (<60 years or ≥60 years), sex (male/female), size of tumor (< 3cm or ≥ 3cm), number of tumors (solitary/multiple) and grade (high/low) were evaluated using EpiInfoV.7 software version and chi-square test. Results: The age of patients ranged from 36 to 89 years. Male preponderance was observed. Most common clinical presentation was painless hematuria. EGFR positivity was observed in majority, 190 cases, irrespective of histological type and grade of tumor. No statistical signicant correlation was found between EGFR expression and age of patient, size of tumor, number of tumor and histological grades of urothelial tumors. Conclusion: Majority of urothelial carcinomas over expressed EGFR irrespective of their histological grade. So, targeted EGFR therapy in urothelial carcinomas can emerge as a novel therapy improving overall survival and prognosis of the patients with urothelial carcinomas.

Endobronchial metastasis of urinary bladder carcinoma

Introduction: Bladder cancer is the 12th most common cancer type worldwide. The most common symptom is painless hematuria. The most common sites of distant metastasis are liver (47%), lung (45%) and bone (32%), respectively. Case report: 73-year-old male patient was admitted with the complaint of hematuria. With a preliminary diagnosis of bladder cancer transurethral resection of tumour (TUR-B) was performed and pathology reported invasive urothelial carcinoma. The patient applied to the pulmonary diseases outpatient clinic with the complaint of cough and wheezing. Bronchoscopy was performed with a pre-diagnosis of bladder cancer metastasis. Multiple biopsies from EBL reported in accordance with urothelial carcinoma metastasis. Result: Urothelial carcinoma of the bladder may present with different pulmonary involvement. Although endobronchial metastasis is a rare condition; it should always be kept in mind in patients with respiratory system complaints. Keywords: endobronchial metastasis; bladder carcinoma; urothelial carcinoma; pulmonary involvement.

Cavernous lymphangioma of the urinary bladder in an adult woman: an additional case report of a rare lesion and literature review

BackgroundUrinary bladder lymphangioma is a rare and benign lesion that is often causes symptoms related to irritation and urinary tract obstruction. Because a lymphangioma may resemble a true neoplasm of the urinary bladder clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy.Case presentationWe present a case of a 40-year-old female who was evaluated for painless gross hematuria. Clinical and diagnostic work up revealed a sharply defined mass involving the wall and bulging into the cavity on the dome of the bladder. Partial cystectomy was performed and histologic findings were compatible with cavernous lymphangioma. The symptom of hematuria relieved after the procedure and the patient was in good status without evidence of recurrence by cystoscopy at follow-up 6 months later.ConclusionsLymphangioma of the urinary bladder is treated with surgical excision and seems to have no recurrence once completely resected, but long-time follow-up may be needed.

Giant Median Lobe Hyperplasia of the Prostate Mimicking Bladder Tumor: A Case Report

Benign prostatic hyperplasia is a common cause of bladder outlet obstruction and may cause macroscopic hematuria. Giant median lobe hyperplasia is very rare and its definition is not clear. In this case report, the diagnosis and treatment of a case with giant median lobe hyperplasia of the prostate mimicking a bladder tumor were evaluated. A 65-year-old male patient was admitted to our clinic with a 9-month history of intermittent hematuria. Abdominopelvic computed tomography revealed a mass measuring 95x85x57 mm filling the bladder. A distinct anatomical plane between the mass and the seminal vesicles could not beidentified. In the urethrocystoscopy, it was determined that the mass was the giant median lobe of the prostate. Open suprapubic prostatectomy was performed. A total of 330 g prostate tissue consisting of 180 g median lobe was enucleated. Giant median lobe hyperplasia of the prostate is a rare pathology and may mimic a bladder tumor by causing painless hematuria.

Incidence of Bladder Cancer at a Tertiary Care Centre in North Karnataka

Background: Understanding the prevalence, clinical characteristics, and changing demographics of Indian Bladder cancer (BC) has emerged as an important field of study. Herein, we aimed to present the case series of BC patients of a single tertiary care centre in North Karnataka. Method: This retrospective study was designed for 14 years from 2004 to 2017, conducted in the urology clinic. A total of 468 newly diagnosed BC patients (M = 415; F = 53) were included in the study. Socio-demographic, clinical characteristics, cystoscopic, and pathological findings were recorded and analyzed via IBM SPSS statistics software Inc. version 20.0. Results: The mean age of the patients was M = 62.27 years and F = 54.22 years. Hematuria was a common clinical symptom in both genders accounting for 42.02 versus 45.28% of the male and female subjects, respectively. Transition cell carcinoma (TCC) was the common variant seen in the male and female participants (92.99 versus 94.88%, respectively). Low-grade cancer was found in patients with >60 years of age in 39.7% versus 42.1% of respectively the males and females (P = 0.002) as compared to the patients <60 years. Non-muscle invasive BC in the males and females was respectively 55.42% versus 52.83%, whereas muscle-invasive cancer was 44.57% versus 47.16% respectively in the two groups (P = 0.008). 53 patients (29.22%) in both the genders received transurethral resection/intravesical Bacilli Calmette-Guerin (BCG) therapy, which showed a significant improvement (P = 0.019). Conclusion: Transition cell carcinoma was found to remain the predominant type of BC with painless hematuria in North Karnataka population. This has seriously affected the public health; this trend is expected to be continued due to the high prevalence of smoking. There should be further emphasis on primary prevention of BC by conducting smoking cessation awareness programs.

Diagnosis and treatment of two imported cases with schistosomiasis haematobia in Fujian Province

To analyze the diagnosis and treatment of two imported cases with schistosomiasis haematobia, so as to provide insights into improving the diagnosis and treatment and avoiding misdiagnosis and mistreatment of imported schistosomiasis haematobia. The medical records and epidemiological data pertaining to the two cases were collected. The stool and urine samples were collected for identification of Schistosoma eggs using the Kato-Katz technique and direct smear method after centrifugal precipitation, and blood samples were collected for detection of anti-Schistosoma antibody. Following definitive diagnosis, the patients were given praziquantel therapy. The patient 1, a Malagasy, was infected in Madagascar and returned to China for delivery. The case presented intermittent painless terminal hematuria symptoms, and showed no remarkable improvements following multiple-round treatments in several hospitals. In January 2017, she was found to be positive for anti-Schistosoma antibody, negative for feces test, and positive for S. haematobium eggs in urine test, and miracidia were hatched from eggs. Then, the case was diagnosed as schistosomiasis haematobia. Patient 2 worked in Republic of Malawi for many years, and presented intermittent painless terminal hematuria since October 2018; however, no definite diagnosis or effective treatment was received after admission to multiple hospitals. In March 2019, pathological examinations showed a number of eggs in the interstitium of the bladder mass, accompanied by a large number of eosinophils, which was consistent with schistosomiasis cystitis. In April 2019, he was tested positive for serum anti-Schistosoma antibody, negative for the fecal test, and had S. haematobium eggs in urine samples, with miracidia hatched from eggs. Then, the case was diagnosed as schistosomiasis haematobia. Following treatment with praziquantel at a dose of 60 mg/kg, all symptoms disappeared. Overseas imported schistosomiasis haematobia is likely to be misdiagnosed. The training pertaining to schistosomiasis control knowledge requires to be improved among clinical professionals, in order to avoid misdiagnosis and mistreatment.

Primary Follicular Dendritic Cell Sarcoma of Urinary Bladder.

Follicular dendritic cell sarcoma is a rare malignant mesenchymal neoplasm composed of follicular dendritic cells. A subset of cases can be found at extranodal sites. Only 2 follicular dendritic cell sarcomas were previously reported in the urinary bladder. We report a follicular dendritic cell sarcoma that involved the urinary bladder of an 81-year-old woman, who presented with painless gross hematuria. The neoplasm was composed of large epithelioid cells with atypical nuclei, admixed with inflammatory cells. On immunohistochemistry, the neoplastic cells were reactive only for CD21, CD35, and vimentin. The tumor was considered unresectable due to its large size and proximity to the iliac vessels and the patient was treated with bortezomib, cyclophosphamide, and dexamethasone. Although a full course of chemotherapy was not completed due to adverse side effects, the tumor was reduced in size. A subsequent involved-field radiotherapy was performed. Three years postdiagnosis and 2 years after the radiotherapy treatment, a recurrent tumor was identified on imaging in the left posterolateral bladder wall. However, at that time the patient was found to have a newly developed advanced colonic adenocarcinoma. Three and a half months later she developed a bowel perforation and died.

SEMINOMA ARISING FROM TESTICULAR AND OVARIAN REMNANTS HERALDS THE EMERGENCE OF A RARE MALE OVOTESTICULAR DISORDER OF SEXUAL DEVELOPMENT

INTRODUCTIONOvotesticular Disorder of Sex Development (OT DSD) or true hermaphroditism is a very rare subset of DSD and accounts for only 5% of cases. It has great phenotypic variability and poses diagnostic challenge to clinicians. It usually presents in childhood with ambiguous genitalia, characterized by histologic demonstration of ovarian and testicular tissues within the same individual. RESULTSWe describe a 22-year-old man with OT DSD complicated by seminoma. He was delivered preterm with ambiguous genitalia and was lost to follow-up. He was raised as a female, at 14 years old, his teachers referred him due to concerns of male phenotype while participating in competitive sports. Phenotypically, he was a developed male with a micropenis, hypospadia, left scrotal cystic structure and empty right scrotum. Chromosomal analysis revealed 46XY and presence of SRY gene. Radiological imaging at age 16 showed fully developed Mullerian structures, with a single cervix and incomplete septate uterus, and an oval structure suggestive of testes at the left hemipelvis. Cysto-genitoscopy demonstrated normal urethra without prostatic urethra, opening at posterodistal bladder neck with blood clots likely representing the vagina. Laparoscopy identified tubulo-nodular structure inside the pelvis suggestive of vas deferens with suspicious early malignant changes. Wolffian remnant and bicornuate uterus were present with a right Fallopian tube with suspicious hydro-corpus. He was advised surgery, however, he defaulted again. He consulted again at age 22 due to pyuria, suprapubic pain and painless cyclical haematuria. Imaging studies demonstrated pyometra, bulky left ovary and bilateral undescended testes suspicious of malignant transformation. Exploratory laparotomy, gonadectomy, subtotal hysterectomy and left orchidectomy were performed. Histopathological examination revealed seminomas arising from testicular and ovarian remnants with suppurative inflammation in the uterus. He was provided testosterone replacement post operatively, and received chemotherapy (etoposide, bleomycin and platinum). CONCLUSIONThe complexity of the case exemplified the pivotal role of multidisciplinary input from various specialties.

Incidental diagnosis of nonfunctional bladder paraganglioma: a case report and literature review

BackgroundNonfunctional bladder paragangliomas is a rare urological disease. It may present clinical, radiology and pathological features similar to bladder cancer, Only scarce reports have been reported. Urologist must identify this generally benign neuroendocrine neoplasm to avoid misdiagnosis.Case presentation A 62-year-old female presented the outpatient department of our hospital with the symptoms of stomachache, frequent micturition, and urination pain for 20 days. Diagnosed with high blood pressure 1 year ago, administered Amlodipine besylate tablets 5 mg po qd occasionally, did not check blood pressure; denied any tumor observation in the family history. Color ultrasound of the urinary system showed a 38 mm × 34 mm hypoechoic mass on the right side of the bladder, CDFI: in the masses, blood supply was sufficient. Cystoscope showed bladder occupying lesion. Biopsy diagnosis: papillary polypoid cystitis was suspected as a malignant change (Fig. 3a). Then, the patient was admitted to our urological department. Further, computer tomography urography considered bladder cancer. Cystoscopy and biopsy failed to define the nature of the lesions in our outpatient department, which prompted a transurethral resection of the bladder tumor. histopathological and immunohistochemical results were diagnosed as bladder paragangliomas. For the reason, the tumor was removed by partial resection of the bladder. The postoperative recovery and follow-up were uneventful.ConclusionsNonfunctional bladder paragangliomas are occasionally found on imaging studies with the symptoms of urinary tract infection or/and intermittent painless hematuria. It may present clinical, radiology and pathological features similar to bladder cancer, so knowledge of this generally benign neuroendocrine neoplasm is of great importance to avoid misdiagnosis. It should be accompanied by the clinical and pathological characteristics of the patient and image changes. Partial resection of the bladder can effectively treat this disease.

High-grade intradiverticulum bladder tumor: A case report.

Introduction and importanceBladder diverticula are mucosal outpunching of the bladder without a muscle layer. It could be detected incidentally or by giving symptoms of its complications.Case presentationA 59-year-old male patient presented with painless gross hematuria. A primary tumor arising in a bladder diverticulum was detected with computed tomography. Partial cystectomy with para-aortic lymph node dissection was performed. The pathology report showed high-grade papillary transitional cell carcinoma (PT3). Unfortunately, the patient died of an acute cardiac event and sepsis after one month postoperative.Clinical discussionOnce patient had a bladder diverticulum, we should expect the patient to have complications. One of that is intradiverticulum bladder malignancy. Imaging studies such computed tomography with contrast should be performed to confirm the diagnosis. Surgical interventions play a major role in the treatment. Most patients present with late, so the survival rate is poor in general.ConclusionIntradiverticulum bladder tumors are a major challenge in urological practice and need multiple investigations to be detected. These types of bladder tumors have high mortality rate.

Bladder Metastasis of rEnal Cell Carcinoma. A Case Report and Review of the Literature

Renal cell carcinoma (RCC) metastasis to the urinary bladder is an exceedingly rare entity. In this paper, we present a case of a 78-year-old male presented in our department with painless gross hematuria, 2 years after he underwent a left open nephrectomy that revealed a clear cell RCC. Imaging examination revealed a sessile mass on the bladder wall. The patient underwent a transurethral resection of the bladder tumor with the histological diagnosis of clear cell RCC. Pathogenesis and possible routes of such a metastasis are not well-documented and no treatment of choice has been established yet.

A Rare Cause of Lower Abdomen Pain – Primary Urinary Bladder Amyloidosis

Primary urinary bladder amyloidosis is a rare disease. Its importance lies in the ability of the disease to masquerade the carcinoma urinary bladder in clinical presentation and imaging but with a distinctively contrasting treatment. The commonest presentation is painless hematuria. Definitive diagnosis is made on histopathology and by ruling out systemic amyloidosis. Here, we report a 60-year-old male presenting with lower abdomen pain diagnosed with primary urinary bladder amyloidosis and discuss the management based on current literature.

Urinary Cytology in the Diagnosis of Bladder Cancer

The examination of urine is an ancient medical procedure dating back thousands of years. Microscopic examination of cells in the urine is being done since the invention of microscope. Presently the cytological examination of urine or other fluid samples from the urinary tract is a routine non-invasive diagnostic procedure to detect cancer of the urinary tract, especially in patients with painless haematuria. It is also used in the follow-up of patients previously treated for bladder cancer to detect recurrence or a new primary. It is a highly specific method for the diagnosis of invasive and in situ urothelial carcinoma and high-grade papillary carcinoma. However, it is unreliable for the detection of low-grade papillary neoplasms. Malignant cytomorphological characteristics of the exfoliated cells in urine or bladder washing can facilitate the diagnosis of bladder cancer. The Paris System (TPS) Working Group has proposed. The Paris System (TPS) authorities have proposed a standard reporting stem which includes specified diagnostic categories and cytomorphologic criteria for diagnosis of High-grade Urothelial Carcinoma (HGUC).

Xp11.2 translocation renal cell carcinoma with osseous metaplasia

Xp11.2 translocation renal cell carcinoma is an uncommon and distinctive subtype of renal neoplasm. Osseous metaplasia with renal cell carcinoma is extremely rare and only less than 20 cases have been reported in the literature distinctly in clear cell, papillary and chromophobe subtypes. There has only been one report of Xp11.2 translocation renal cell carcinoma with osseous metaplasia in an elderly woman. We present the first case of this unusual renal neoplasm associated with osseous metaplasia in an adolescent male with no history of previous exposure to chemotherapy who presented with symptomatic anemia due to painless haematuria. Level of evidence: Level 4.

Hereditary Hemorrhagic Telangiectasia: A Case Report with Hematuria as Primary Presentation

Hematuria is a concerning sign that warrants evaluation because it may signal the presence of a genitourinary malignancy. Full urologic evaluation for hematuria must be done after excluding pseudohematuria, history of nephrological pathology, trauma, or recent urologic manipulation. One of the rare causes of gross hematuria: hereditary hemorrhagic telangiectasia (HHT) that must be considered in the differential diagnosis of haematuria of unknown cause. In this case we describe a rare primary presentation of hereditary hemorrhagic telangiectasia with painless gross haematuria and urethral bleeding. We present a case of a 21-year-old Saudi male with a history of painless gross haematuria and urethral bleeding. Urinary tract infection (UTI), nephropathy and bleeding diathesis had been investigated and were excluded. Computed tomography (CT) scan showed no pathological lesions. The patient underwent urethro-cystoscopy and multiple telangiectatic lesions were observed in the penile urethra and in the trigone of the bladder. We also found another telangiectasias lesion in the oral mucosa. With these findings, this patient was diagnosed with probable HHT based on Curaçao’s diagnostic criteria. However, other differential diagnoses other than solitary telangiectasia of the bladder were excluded. HHT, despite a rare cause, must be considered in the differential diagnosis of haematuria of unknown cause. Conservative management with close follow up to prevent complications can be a potential line of management in these cases with stable condition before proceeding to medical or surgical treatment.

Inflammatory myofibroblastic tumor of the urinary bladder: treatment and a two-year monitoring - case report

Introduction. Inflammatory myofibroblastic tumor of the bladder or inflammatory pseudotumor is benign in nature. It is also known as a pseudotumor, because it macroscopically mimics infiltrative tumors of the bladder. The first inflammatory pseudotumor ever described was found in the lungs. In the 80s of the last century, it was first described in the urinary bladder. Its etiology is unknown and the incidence is extremely rare. Case Report. We present a case of a 46-year-old man who came to the Emergency Center for the first time due to an unpleasant feeling when urinating, painless hematuria and appearance of blood clots during urination. An urgent diagnosis revealed a tumor mass in the bladder. Additional diagnostics and surgical treatment was performed by transurethral electroresection of the urinary bladder. After the histopathological examination, an inflammatory myofibroblastic tumor of the bladder was diagnosed. The patient was discharged on the third day of admission. On control examinations, the patient underwent only cystoscopy and ultrasonography. No recurrences were observed. Conclusion. A review of the available literature showed that in such cases, after transurethral resection of bladder tumor, most urologists opted for more radical surgical procedures. After a two-year follow-up, we proved that a tumor of the bladder can be kept under control after transurethral resection of bladder tumor, without recurrence, by regular monitoring using ultrasonography and cystoscopy.

A variant of Zinner syndrome presenting with terminal hematuria: A case report

Introduction. Zinner syndrome is a rare congenital malformation characterized by ipsilateral renal agenesis or hypoplasia, seminal vesicle cysts, and ejaculatory duct obstruction. Patients are usually asymptomatic or develop unspecific symptoms. Case Report. We present a case of a 22-year-old male patient who presented with painless terminal hematuria. The patient denied trauma or other urinary tract symptoms. Magnetic resonance imaging of the abdomen and pelvis revealed a right renal hypoplasia, a tortuous dilated right ureter draining into polycystic right seminal vesicle, and a dilated ejaculatory duct. Conclusion. The size of the seminal vesicle cyst and symptoms affect the treatment. Asymptomatic cysts may be treated conservatively, while cysts that cause symptoms are often an indication for surgical treatment, due to the possibility of infertility caused by the obstruction of the ejaculatory canal. Magnetic resonance imaging has high-resolution properties providing excellent presentation of anatomical relationships and pathology which is extremely important in case of the need for surgical treatment.

Clinicopathological Spectrum of Urothelial Carcinoma – A Study from Tertiary Care Set Up

Background: Urothelial carcinoma is the most common malignancy encountered in genitourinary tract. Urinary bladder cancer is the 7th most common malignant tumor worldwide. It is a disease of older age group. Objective: To determine the demographic characteristics of urinary bladder cancer and to analyze the cases of urothelial carcinoma according to gender, age, grade, invasion, histologic subtype, presenting complaints and pathologic stage of specimens. Study Design: Retrospective study. Settings: Pathology Department of Faisalabad Medical University from Department of Urology of Allied Hospital Faisalabad Pakistan. Duration: Three years (January 2015-December 2018). Methodology: Total 305 cases were included in this study. Results: 226 were male patients (74%), and 79 (26%) were females.&nbsp; Majority of the patients (62%) with urothelial carcinoma in this study were in their 5th and 6th decade of their life. Only 27 patients (8.8%) were below 40 years. Of total cases 149(48%) were of low grade, 150(49%) were of high grade and only 6 cases (2%) fell under the category of lesion named PUNLMP. 151(49%) cases were detrusor muscle invasive and 151(49%) were non-invasive and only 3 (1%) cases were found in which no muscle biopsy was identified. 99% of patients were diagnosed with commonest type of tumor that is transitional cell carcinoma, while only 3 (1%) cases were of transitional cell carcinoma with squamous differentiation. Painless visible hematuria was the most common presenting complaint (96%) followed by dysuria (3%) and storage symptoms (1%). Majority patients lie under the pathologic stage pT1(50%) then in pT2(48%). A significant co-relation was found between gender and a grade of tumor. Female patients (60%) presented with higher grade and aggressive disease. Patients of younger age group (below 40) were diagnosed with low grade carcinoma.&nbsp;Conclusion: Urothelial carcinoma is a disease of elderly people with a significant predominance of male patients. Painless hematuria is the most common presenting symptom.

Renal Urothelial Carcinoma Complicated by Inferior Vena Cava Tumor Thrombus and Acute Pyelonephritis

Renal urothelial carcinoma (UC) with inferior vena cava tumor thrombus is rare, especially when it is concomitant with acute pyelonephritis. In this report, a 70-year-old diabetic man with right flank pain, intermittent painless gross hematuria, and recurrent high fever was described. On the basis of the symptoms, physical examination, cytology and imaging results, renal UC with extension into inferior vena cava, and acute pyelonephritis was established. The patient was unresponsive to antimicrobial chemotherapy. Nephroureterectomy, lymphadenectomy, thrombectomy, and bladder cuff excision were performed. Postoperative histopathological examination revealed high grade UC and lymph node metastasis.

Breast cancer metastasis to urinary bladder related hematuria and concomitant venous thromboembolism—case report of a challenging clinical scenario

: Breast cancer metastasis to the urinary bladder is uncommon and its true incidence may be underreported, requiring a high level of clinical suspicion to diagnose them. Venous thromboembolism (VTE) is a known complication in breast cancer and guidelines recommend treatment with the use of anticoagulation therapy unless contraindicated by active bleed or high bleeding risk. We present a rare case of 42-year-old female patient presenting with concurrent VTE and visible hematuria due to breast cancer metastasis to the urinary bladder. The patient initially underwent radical mastectomy and axillary lymph node dissection for high grade invasive ductal breast carcinoma (pT3N3cM0). Despite adjuvant radiotherapy, chemotherapy and hormonal therapy, the patient subsequently developed interval liver and bladder metastasis. She presented with right lower limb VTE 6 years after the initial mastectomy. The patient developed painless visible hematuria after starting anticoagulation therapy. Hence treatment of VTE was contraindicated and was managed instead with insertion of an inferior vena cava (IVC) filter. In the literature, breast cancer metastasis to the urinary bladder is rare, with 65 published to date. Our case report is unique as there was concomitant symptomatic VTE, thereby posing a clinical challenge of not being able to use anticoagulation therapy. We postulate that as the cancer specific and overall survival rates for breast cancer patients continues to improve, the incidence of patients presenting with metastasis to the urinary bladder may increase. Urinary bladder metastasis in breast cancer populations have variable presentations, requiring a high level of clinical suspicion. Prompt collaboration with urologists and pathologists is recommended in this group of patients who complaints of hematuria. Prognosis is usually poor and the optimal management is currently unknown.