GIANT SIZED EXTRAVESICAL BLADDER LEIOMYOMA MIMICKING UTERINE CERVICAL LEIOMYOMA: A CASE REPORT WITH 8 YEARS’ POSTOPERATIVE FOLLOW-UP AND A REVIEW OF THE LITERATURE

Öz

The incidence of bladder leiomyoma is estimated at only 0.43% because most bladder tumors arise from the urothelium. Moreover, 30% of them are the extra-vesical type. The symptoms include urinary tract obstruction, bladder irritation, and dysuria, with the possibility of dyspareunia or hematuria depending on the size and location of the tumor. Bladder leiomyomas cannot be diagnosed solely by combining symptoms and imaging techniques. We present a rare case of giant sized extravesical-type bladder leiomyoma with a diameter of 15.5x14.5x14 cm, which was misdiagnosed as a uterine cervical leiomyoma. It caused unilateral ureteral distension without related symptoms. During the 8-year postoperative follow-up, the patient had two healthy full-term pregnancies and no recurrence was observed. We reviewed the literature of the most recent five years and discussed the characteristics of 22 bladder leiomyoma cases. Unlike the literature, the present case is unique due to the giant size of the bladder leiomyoma, its ureteral complications, and long follow-up period. Bladder leiomyomas are rare bladder tumors which should be borne in mind during the differential diagnosis of a pelvic mass. Surgical excision is the most useful procedure for diagnosis and treatment.

Anahtar Kelimeler

• Bladder leiomyoma
• bladder tumor
• cervical leiomyoma
• cervical tumor
• differential diagnosis

UTERİN SERVİKAL LEİOMYOMU TAKLİT EDEN DEV EKSTRAVEZİKAL MESANE LEİOMYOMU: 8 YILLIK POSTOPERATİF TAKİBİ VE LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ

Öz

Mesane leiomyomunun insidansı sadece %0,43 olarak tahmin edilmektedir; çünkü mesane tümörlerinin çoğu üroepitelyumdan kaynaklanmaktadır. Bunun yanı sıra, mesane leiomyomlarının sadece %30’u ekstra-vezikal tiptedir. Üriner sistem obstrüksiyonu, mesane irritasyonu, dizüri, disparoni veya hematüri gibi semptomlar kitlenin boyut ve yerine göre değişebilir. Yalnızca semptom ve görüntüleme tekniklerine dayanarak mesane leiomyomu tanısı konulamayabilmektedir. Preoperatif uterin servikal leiomyom ön tanısı düşünülen, 15,5x14,5x14 cm çapında tek taraflı üreteral distansiyona yol açan, nadir görülen bir ekstravezikal tip mesane leiomyomu olgusunu sunuyoruz. Sekiz yıllık postoperatif takip boyunca, hastanın iki sağlıklı term gebeliği mevcuttu ve nüks izlenmedi. Son beş yılın literatürü gözden geçirilerek 22 mesane leiomyomunun özellikleri sunuldu. Literatürden farklı olarak, mevcut olgu mesane leiomyomunun büyüklüğü, üreteral komplikasyonları ve uzun takip süresi ile benzersizdir. Mesane leiomyomları, pelvik kitlenin ayırıcı tanısında göz önünde tutulması gereken, nadir görülen mesane tümörleridir. Tanı ve tedavi için en faydalı prosedür cerrahi eksizyondur.

Anahtar Kelimeler

• Mesane leiomyomu
• mesane tümörü
• servikal leiomyom
• servikal tümör
• ayırıcı tanı

Kaynakça

1. 1. He L, Li S, Zheng C, Wang C. Rare symptomatic bladder leiomyoma: case report and literature review. J Int Med Res 2018;46(4):1678-84. [CrossRef]
2. 2. Park JW, Jeong BC, Seo SI, Jeon SS, Kwon GY, Lee HM. Leiomyoma of the urinary bladder: a series of nine cases and review of the literature. Urology 2010;76(6):1425-9. [CrossRef]
3. 3. Li A, Zhang P, Zhang M, Yang T, Yue Y, Chen G, et al. Transurethral Enucleation of Bladder Leiomyoma: A Series of Six Cases and Review of the Literature. Urol Int 2019;102(1):102-8. [CrossRef]
4. 4. Xin J, Lai HP, Lin SK, Zhang QQ, Shao CX, Jin L, et al. Bladder leiomyoma presenting as dyspareunia: Case report and literature review. Medicine (Baltimore) 2016;95(28):e3971. [CrossRef]
5. 5. Sharma A, Vadi SK, Sood A, Kumar S, Mete UK, Parkhi M, et al. Bladder Leiomyoma: A Rare Differential and a Potential Pitfall in the Evaluation for a Bladder Mass in (18) F-Fluorodeoxyglucose-Positron Emission Tomography/ Computed Tomography. Indian J Nucl Med 2018;33(3):264-5.
6. 6. Pramod SV, Safriadi F, Hernowo BS, Dwiyana RF, Ksatriapraja RA. A large bladder leiomyoma. Urol Case Rep 2020;32:101211. [CrossRef]
7. 7. Mitchell K, Barnard J, Luchey A. Locally Recurrent Leiomyoma of the Bladder Refractory to Visually Complete Transurethral Resection: An Indication for Cystoprostatectomy. Case Rep Urol 2019;2019:1086575. [CrossRef]
8. 8. Fridman D, Abeshouse M, Sankin A. Paraurethral Leiomyoma as an Incidental Finding in Patient with Fibroid Uterus. Case Rep Obstet Gynecol 2018;2018:7042960. [CrossRef]

9. 9. Yucel C, Budak S, Kisa E, Celik O, Kozacioglu Z. The Rare Togetherness of Bladder Leiomyoma and Neurofibromatosis. Case Rep Urol 2018;2018:2302918. [CrossRef]
10. 10. Sodo M, Spirito L, La Rocca R, Bracale U, Imbimbo C. Partial cystectomy in young male for a urachal tumor masquerading a bladder leiomyoma. Arch Ital Urol Androl 2019;91(1):51-2. [CrossRef]
11. 11. Zachoval R, Dukatova K, Svabik K. Vaginal ultrasound for imaging of a urinary bladder mass and treatment of a large leiomyoma of the urinary bladder in pregnancy. Int Urogynecol J 2018;29(4):601-2. [CrossRef]
12. 12. Mavridis C, Georgiadis G, Lagoudaki ED, Skamagkas I, Heretis I, Koutsopoulos AV, et al. Bladder Leiomyoma with Synchronous Solitary Fibrous Tumor of the Pleura. Case Rep Urol 2020;2020:3717506. [CrossRef]
13. 13. Tobias-Machado M, Pazeto CL, Borges RC. Robot-assisted transvesical partial cystectomy for leiomyoma of bladder trigone. Int Braz J Urol 2020;46(2):300.
14. 14. Delara R, Wasson M, Khan A. Bladder Leiomyoma. J Minim Invasive Gynecol. 2021 Jan 4: S1553-4650(21)00002-9. [CrossRef]
15. 15. Mendes JE, Ferreira AV, Coelho SA, Gil C. Bladder leiomyoma. Urol Ann 2017;9(3):275-7. [CrossRef]
16. 16. Dodia B, Mahajan A, Amlani D, Bathe S. Leiomyoma of Urinary Bladder in Middle-Aged Female. J Obstet Gynaecol India 2017;67(2):147-9. [CrossRef]
17. 17. Jamshaid A, Arshad Z, Zaidi SZ. Leiomyoma of the urinary bladder. J Pac Med Assoc 2017;67(9):1447-9.
18. 18. Haddad RG, Murshidi MM, Abu Shahin N, Murshidi MM. Leiomyoma of Urinary Bladder Presenting with Febrile Urinary Tract Infection: A Case Report. Int J Surg Case Rep 2016;27:180-2. [CrossRef]
19. 19. Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, et al. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging 2019;100(10):619-34. [CrossRef]
20. 20. Glaser LM, Friedman J, Tsai S, Chaudhari A, Milad M. Laparoscopic myomectomy and morcellation: A review of techniques, outcomes, and practice guidelines. Best Pract Res Clin Obstet Gynaecol 2018;46:99-112. [CrossRef]
21. 21. Barlotta R, Edwards DC, McGreen B, Levy J, Xia G, Brennan M, et al. Incidental Asymptomatic Leiomyoma of the Urinary Bladder. Urology 2018;113:6-9. [CrossRef]