‘No visible lesions?’—an unusual case of Intestinal metaplasia of the bladder

Abstract

Intestinal metaplasia (IM) of the bladder is an extremely rare benign condition. The clinical features are similar to other bladder tumours. Its pathogenesis is unclear and its role as a precursor of adenocarcinoma has long been debated. Transurethral resection is the main form of treatment for IM. We report the case of a 49-year-old gentleman who presented with visible haematuria. He was submitted to multiple cystoscopies which showed no macroscopic irregularities. Radiological (CT urogram and multiparametric MRI) imaging revealed abnormalities within the bladder neck, suspicious of a neoplastic lesion. Following transurethral resection of his trigonal area, pathology demonstrated IM occurring on a background of cystitis glandularis. This case highlights the unusual difficulty in macroscopically diagnosing IM of the bladder compared to other neoplasms of the bladder. Therefore, in patients with persistent visible haematuria there should be a low threshold to perform biopsies.

Pseudo Tumor of the Bladder Simulating Cancer: Pseudotumoral Glandular Cystitis

“…Moreover, we often observe a densification of the perivesical fat, not found in our observation. In our context, only lecho-abdominopelvic was performed but it did not objectify the lesion [6]. Cystoscopy with trans-urethral resection objectives a lesion with a plane or polypoid appearance, with a preferential trigonal location, it also assesses the state of ureteral meatus.…”

“…It is based on the presence of marked atypia, glandular architectural disorder, desmoplastic stroma, muscle invasion, necrosis, high mitotic index, carcinoma in situ and the presence of isolated atypical cells floating in the mucin. Immunohistochemistry by testing for beta-catenin nuclear markers may be useful [6]. The prognosis of this pathology is controversial in the literature, some authors consider it as a precancerous lesion of denocarcinoma of the bladder.…”

“…[1,3,7] The preferred treatment for the localized florida form is endoscopic resection. However, 5% of cases can recur or progress to malignancy [1][2][3][4][5][6][7].…”

“…Considering an uncontrolled pathophysiology, the treated patients must be followed by endoscopic or radiological watch, although it is not codified. In our context a minimum annual cystoscopy is allowed [6].…”