Primary localized amyloidosis of the urinary bladder (original) (raw)
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Primary localized amyloidosis of urinary bladder: a case report and review of literature
Nephro-urology monthly, 2013
Amyloidosis is a disorder of protein metabolism characterized by extracellular deposition of abnormal protein fibrils. It may either be localized to any organ or systematically distributed throughout the body. The biochemical nature of proteins varies but the physical and tinctorial properties are shared by all the amyloidogenic proteins. In the West, it is mainly composed of amyloid light (AL) type immunoglobulin (Ig) light chains. Amyloidosis of the genitourinary tract is rare except for the kidney and isolated primary amyloidosis of the urinary bladder is even rarer. It mainly presents as intermittent painless gross hematuria. It mimics transitional cell carcinoma on imaging and endoscopic examination. We herein present a case of fifty six-years-old male with history of painless hematuria for three months. Cystoscopy revealed a 1 cm hyperemic area on the posterior wall of urinary bladder. The biopsy showed features of amyloidosis and amyloid A (AA) immunostaining was negative. Extensive workup was done to exclude other sites of involvement and a final diagnosis of primary localized amyloidosis of the urinary bladder was made. The patient is on regular follow-up.
Primary localized amyloidosis of urinary bladder
Urology, 1980
Primary localized amyloidosis of the bladder is rare. Two new cases are presented, and 44 cases from the literature are reviewed. The disease tends to occur in a younger age group in men than in women. It presents most frequently with gross painless hematuria, and usually appears at cystoscopy as a tumefied, yellowish, and occasionally ulcerated lesion. The amyloid deposits usually involve suhurothelial connective tissue, suburothelial vessels, and less markedly the vesical muscularis. The treatment varies from transurethral resection to total cysteetorny with urinary diversion. Transurethral resection appears to be the treatment of choice, if feasible. Close follow-up of the patient is necessary because of the frequency of multiple recurrences, which may require, an ablative procedure .
Localized amyloidosis of the urinary tract: Case series of nine patients
Urology, 2006
Objectives. To report 9 cases of primary localized amyloidosis of the urinary tract and correlate the pathologic findings with clinical and cystoscopic information. Methods. Patients diagnosed with amyloidosis of the ureters, urinary bladder, or urethra from 1976 to 2003 were identified. Their medical records were reviewed, and histochemical and immunoperoxidase stains were performed on the tissue. Results. Eight cases of amyloidosis of the urinary bladder and one of the renal pelvis/ureter were identified. None of our cases showed evidence of systemic amyloidosis. Of the 8 patients with amyloidosis of the urinary bladder, 5 presented with gross hematuria and 1 with irritative bladder symptoms and 2 had amyloidosis detected during cystoscopic follow-up for urothelial carcinoma. The patient with amyloidosis of the renal pelvis/ureter presented with flank pain and gross hematuria. The clinical impression was malignancy in 75% of the bladder cases. Most patients with bladder involvement were treated with localized bladder resection; however, 1 patient required total cystectomy for symptom control. Of 5 patients with follow-up information, 2 developed recurrence. The pathologic assessment diagnosed amyloid deposits consistent with primary or AL type amyloid in all cases. Immunoperoxidase stains revealed lymphoid cells in the vicinity of the amyloid deposits to be lambda-restricted in 78% of cases. Conclusions. Primary amyloidosis of the urinary tract is a rare condition that mimics malignancy in its clinical presentation and cystoscopic appearance and on diagnostic imaging. In our study, all cases of urinary amyloid deposits represented localized amyloidosis rather than manifestations of systemic amyloidosis. Monoclonal lymphoid populations evolving from chronic inflammation in the urinary tract may be the source of the amyloid AL proteins. UROLOGY 67: 904-909, 2006.
Primary Localized Amyloidosis of the Bladder Mimicking Neoplasia
Journal of Urological Surgery, 2018
A 63-year-old woman was admitted to our hospital with macroscopic hematuria in 2013. On computed tomography, the bladder wall thickness was 2 cm, suspicious for malignancy. Cystoscopy showed irregularity in the posterolateral side of the bladder. Transurethral resection was performed. Histopathological examination revealed a dense homogeneous eosinophilic material in the lamina propria which showed positive orange-red staining with apple-green birefringence under polarized light. There were no signs of systemic amyloidosis at the time of diagnosis and during the 36 months of follow-up. Differential diagnosis of amyloidosis in the bladder includes urothelial carcinoma due to its appearance on imaging and cystoscopy. Histopathological evaluation is a requirement for accurate diagnosis.
International Journal of Surgery Case Reports, 2020
INTRODUCTION: Localised amyloidosis of the urinary tract is rare and often presents with haematuria. PRESENTATION OF CASE: A 59 year old male presented with recurrent episodes of frank haematuria exacerbated by anticoagulation after a minor stroke. He had a background of hypertension, hypercholesterolaemia, and Parkinson's disease. Initial investigations did not reveal a cause, but eventual cystoscopic biopsy showed bladder mucosa expanded by deposits of amorphous, pale, eosinophilic, proteinaceous material and immunohistochemical staining revealed the presence of amyloid deposition. Workup for systemic amyloidosis was negative. A diagnosis of primary localised amyloidosis of the bladder was made. Trans-urethral resection was performed and annual cystoscopic surveillance was commenced. He was followed up for 11 years without recurrence. DISCUSSION: A comprehensive literature review revealed 349 published cases of localised amyloidosis of the urinary tract, with a median age of 57 (interquartile range 49-69), and a male preponderance (1.5 to 1). Painless visible haematuria (65%) was the most frequent presenting complaint and the bladder was the most common site of involvement (71%). Transurethral resection was the most common form of management (42%) but a proportion of patients underwent more radical surgery (nephroureterectomy/nephrectomy 9%, cystectomy 1%). Median follow up was 33 months (interquartile range 12-108) and 35% of patients had recurrent disease. This patient represents a typical case of localised amyloidosis of the urinary tract. CONCLUSION: This is the most up to date review of the literature describing localised amyloidosis of the urinary tract. The disease is rare, but salient to the urologist as it invariably mimics urinary tract malignancy.
Localized amyloidosis of urinary bladder: A diagnostic dilemma
Indian Journal of Pathology and Microbiology, 2008
Amyloidosis is a heterogeneous group of disorders affecting a single-or multiple-organ system and presents as generalized or localized disease. Both generalized amyloidosis and localized amyloidosis can be primary or secondary. Localized amyloidosis affects organs like urinary bladder, lung, larynx, skin, tongue and the region around the eye, producing detectable nodular masses which are clinically suspected as malignancy. We present six cases of localized urinary bladder amyloidosis that were clinically and cystoscopically suspected as bladder tumor or cystitis, which occurred over a period of last 10 years. Histology in all cases revealed diagnosis of primary amyloidosis. None of them had any stigmata of secondary disease. The cases were treated by simple transurethral resection of bladder. Two out of the six cases recurred after 3 to 5 years of initial presentation and were asymptomatic thereafter. Amyloidosis of the bladder is a rare condition which often mimics bladder neoplasm clinically and cystoscopically and histological examination is a must for defi nite diagnosis and proper management.
2013
Primary amyloidosis involving urinary tract is a rare. In this we reviewed the literature on primary amyloidosis of the urinary bladder, ureter, renal pelvis and urethra. Various internet search engines were used to identify reported cases and case series regarding primary amyloidosis of lining of the urinary tract. Amyloidosis of the urinary tract may either be primary or part of a systemic disease. Localized amyloidosis is of unknown aetiology but mostly of AL-type amyloid immunoglobulin light chains. Systemic amyloidosis can be either primary (AL-type amyloid), secondary (AA-type amyloid) or familial (ATTR-type amyloid). Systemic secondaryurinary bladder amyloidosis tends to be associated with autoimmune disease and chronic infection. Familial cases of systemic amyloidosis tend to be associated with mutations in the transthyretin gene. Primary amyloidosis of the urinary tract may present with haematuria; lower urinary tract symptoms; loin pain. Useful investigations in the diagno...
Primary Localized Vesical Amyloidosis Mimicking Bladder Carcinoma: A Case Report
Iranian Journal of Pathology, 2016
Amyloidosis of urinary bladder is a rare condition and may be primary or secondary in nature. A case of primary localized vesical amyloidosis (VA) in a 40-yr-old man is described which was confused with neoplasm by cystoscopic, urographic and other studies. Surgical specimens obtained by transurethral resection (TUR) were diagnostic and histologically revealed amyloid deposits in sub-epithelial stroma with chronic inflammatory and giant-cell reaction. Congo-red staining proved its amyloid nature. It was resistant to potassium permanganate (KMnO4) pretreatment, indicating it to be of the AL type.