Safar Omar, Al-Qahtani Abdulhadi, Al-Qahtani Saad
Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte P.O. Box 101, Saudi Arabia.
Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte P.O. Box 101, Saudi Arabia.
Diagnostics (Basel). 2023 Feb 25;13(5):875. doi: 10.3390/diagnostics13050875.
Hemangiomas are benign blood vessel and capillary tumor growths which are widespread in many organs but extremely rare in the bladder, making up just 0.6% of all bladder tumors. To the best of our knowledge, few cases of bladder hemangioma are associated with pregnancy in the literature, and no bladder hemangiomas have been discovered incidentally after abortion. The use of angioembolization is well established; however, postoperative follow-up is crucial to identify tumor recurrence or residual disease. Case presentation: In 2013, a 38-year-old female was referred to a urology clinic with an incidental finding after an abortion of a large bladder mass identified incidentally using ultrasound (US). The patient was recommended for CT, which reported a polypoidal hypervascular lesion, as previously described arising from the urinary bladder wall. Diagnostic cystoscopy showed a large, bluish-red, pulsatile, vascularized submucosal mass with large dilated submucosal vessels, a wide-based stalk, and no active bleeding in the posterior wall of the urinary bladder, measuring about 2 × 3 cm, with negative urine cytology. Due to the vascular nature of the lesion and no active bleeding, the decision was made not to biopsy. The patient underwent angioembolization and scheduled for US every six months with regular diagnostic cystoscopy. In 2018, at 5 years of follow-up, the patient developed recurrence after a successful pregnancy. The angiography revealed recanalization of the previously embolized left superior vesical arteries from the anterior division of the left internal iliac artery, resulting in arteriovenous malformation (AVM). The second angioembolization was performed, with the total exclusion of AVM without residual. By the end of 2022, the patient had remained asymptomatic and without recurrence. Conclusion: Angioembolization is a safe treatment technique, minimally invasive, and has less effect on the quality of life, especially in young patients. Long-term follow-up is essential for detecting tumor recurrence or residual disease.
血管瘤是良性血管和毛细血管肿瘤性生长物，在许多器官中广泛存在，但在膀胱中极为罕见，仅占所有膀胱肿瘤的0.6%。据我们所知，文献中很少有膀胱血管瘤与妊娠相关的病例，且流产后未偶然发现膀胱血管瘤。血管栓塞术的应用已得到充分证实；然而，术后随访对于识别肿瘤复发或残留疾病至关重要。病例报告：2013年，一名38岁女性在流产后经超声（US）偶然发现膀胱有一个大肿块，随后被转诊至泌尿外科诊所。建议患者进行CT检查，CT报告显示为息肉样高血管病变，如先前所述，起源于膀胱壁。诊断性膀胱镜检查显示膀胱后壁有一个大的、蓝红色、搏动性、血管化的黏膜下肿块，有大的扩张黏膜下血管、宽基底蒂，且无活动性出血，大小约为2×3 cm，尿液细胞学检查为阴性。由于病变的血管性质且无活动性出血，决定不进行活检。患者接受了血管栓塞术，并计划每六个月进行一次超声检查和定期诊断性膀胱镜检查。2018年，在随访5年时，患者在成功妊娠后出现复发。血管造影显示先前栓塞的左髂内动脉前支的左膀胱上动脉再通，导致动静脉畸形（AVM）。进行了第二次血管栓塞术，完全排除了AVM且无残留。截至2022年底，患者一直无症状且无复发。结论：血管栓塞术是一种安全的治疗技术，微创，对生活质量影响较小，尤其适用于年轻患者。长期随访对于检测肿瘤复发或残留疾病至关重要。
