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Abstract
Atypical bladder leiomyoma is a rare bladder tumor that is difficult to be correctly identified by imaging techniques or cystoscopy. We present the imaging characteristics of an atypical bladder leiomyoma and review the relative literature, with the aim of enhancing awareness of the differential diagnosis of bladder leiomyoma, to avoid and reduce misdiagnosis. The imaging characteristics of the atypical leiomyoma were the cauliflower shaped, abundant vascularity, and calcification foci on the surface of the tumor. The patient was misdiagnosed with bladder cancer after an imaging study. The histopathological study established the definitive diagnosis.
Keywords: urinary bladder, leiomyoma, ultrasound, computed tomography, magnetic resonance imaging
Introduction
Benign tumors of the bladder are rare [1,2], and their sonographic features are usually homogenous hypoechoic, with circumscribed margin and few blood vessels on color Doppler ultrasound. The ultrasonographic and contrast enhanced computed tomography characteristics of the typical leiomyoma of the bladder are exemplified in figure 1 and figure 2. However, the bladder tumors may have variant aspects on imaging evaluation, which may cause misinterpretation and be confused with bladder cancer. Imaging description of atypical leiomyoma of the urinary bladder is rare. The aim of this case report is to delineate imaging aspects of an atypical leiomyoma of the urinary bladder.
Case report
A 49-year-old man presented with gross hematuria, dysuria, and pollakiuria. He complained of a nearly 3-month history of intermittent gross hematuria. Previ- ous ultrasound examination of the bladder was suggestive of bladder stone and cystitis and he was treated for diagnosis. He denied any other medical problems. Physical examination did not reveal any particular findings. Microscopic examination of the urine showed few white blood cells and abundant red blood cells. Blood urea and serum creatinine were within normal limits. The other results of laboratory evaluation were also within the normal limits. Transabdominal ultrasound (US), contrast enhanced computed tomography (CT), magnetic resonance imaging (MRI), and cystoscopy were performed.
US, including Doppler study revealed an irregular shaped heterogenous hypoechoic mass in the neck of the bladder, with cauliflower-like hyperechoic surface, marked posterior acoustic attenuation, a distinct twinkling sign, and abundant blood vessels (fig 3), with resistive index of 0.75 in one of the arterial vessel. The rest of the bladder's walls, the kidneys, the ureters, and the...