Song Jeonghwa, Song Heekyoung, Kim Yong-Wook
Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon 21431, South Korea.
World J Clin Cases. 2022 Oct 16;10(29):10728-10734. doi: 10.12998/wjcc.v10.i29.10728.
Tumors originating from the posterior bladder wall can be challenging to diagnose because they may mimic a mass from the uterine cervix. Atypical leiomyoma of the bladder trigone is extremely rare, with few reported cases, and requires caution during surgery to avoid damage to the adjacent ureter. Diagnostic surgery and confirmational pathology are essential to assess whether the tumor is malignant and relieve clinical symptoms. Herein, we describe a case of recurrent leiomyoma with focal atypia in the bladder trigone.
A 29-year-old woman with a uterine fibroid incidentally found at a regular checkup was referred to our hospital. Based on magnetic resonance imaging, either urinary bladder leiomyoma or protrusion of pedunculated uterine cervical fibroid into the bladder was suspected. This leiomyoma in the trigone of the bladder was completely excised by laparotomy, and the patient was discharged without complication. Follow-up outpatient ultrasonography identified tumor recurrence after four years. As focal atypia was identified previously, laparotomy was performed to confirm the pathology. A round solid mass was resected from the posterior bladder wall without injuring either ureteric orifice. This tumor was pathologically diagnosed as a leiomyoma without atypia. Three-year follow-up ultrasonography has revealed no recurrence.
Atypical leiomyoma in bladder trigone is rare and could be easily mistaken for fibroid in the uterine cervix. To confirm histopathology, surgical excision is mandatory and regular follow-up is necessary to detect recurrence.
起源于膀胱后壁的肿瘤诊断颇具挑战性，因为它们可能类似来自子宫颈的肿块。膀胱三角区非典型平滑肌瘤极为罕见，报道病例极少，手术时需谨慎操作以避免损伤相邻输尿管。诊断性手术及确诊性病理检查对于评估肿瘤是否为恶性及缓解临床症状至关重要。在此，我们描述一例膀胱三角区复发性平滑肌瘤伴局灶性非典型性的病例。
一名29岁女性在定期体检时偶然发现患有子宫肌瘤，遂转诊至我院。根据磁共振成像，怀疑为膀胱平滑肌瘤或带蒂子宫颈肌瘤突入膀胱。通过剖腹手术将膀胱三角区的该平滑肌瘤完整切除，患者术后无并发症出院。随访门诊超声检查发现四年后肿瘤复发。鉴于之前已发现局灶性非典型性，遂再次进行剖腹手术以明确病理。从膀胱后壁切除一个圆形实性肿块且未损伤输尿管口。该肿瘤经病理诊断为无非典型性的平滑肌瘤。三年的随访超声检查未发现复发。
膀胱三角区非典型平滑肌瘤罕见，易被误诊为子宫颈肌瘤。为明确组织病理学，必须进行手术切除且需定期随访以检测复发情况。
