Korean J Urol.  2012 Sep;53(9):657-661. 10.4111/kju.2012.53.9.657.

Malignant Inflammatory Myofibroblastic Tumor of the Bladder with Rapid Progression

• Kim HW
• Choi YH
• Kang SM
• Ku JY
• Ahn JH
• Kim JM
• Chung JM
• Ha HK
• Chung MK

• KMID: 2061707
• DOI: http://doi.org/10.4111/kju.2012.53.9.657

Abstract

A 71-year-old man was referred for painless hematuria and a bladder tumor. Cystoscopy and computed tomography revealed a 3-cm oval nodular mass on the left lateral side of the bladder. The patient underwent a complete transurethral resection of the lesion and histology showed a proliferation of atypical spindle cells with inflammation consistent with a myofibroblastic tumor. After 4 and 7 months, follow-up cystoscopy demonstrated nodular mass lesions and transurethral resection of bladder tumor was done, which showed chronic cystitis and a recurred myofibroblastic tumor, respectively. Five months later, multiple lymph node, bone, and soft tissue metastases were found by positron emission tomography. The patient was treated first with palliative chemotherapy, including doxorubicin and cisplatin. After that, radiologic studies showed disease progression but the patient refused further treatment and died 6 months later.

Keyword

Inflammatory myofibroblastic tumor; Neoplasm metastasis; Urinary bladder

MeSH Terms

Aged
Cisplatin
Cystitis
Cystoscopy
Disease Progression
Doxorubicin
Follow-Up Studies
Hematuria
Humans
Inflammation
Lymph Nodes
Myofibroblasts
Neoplasm Metastasis
Positron-Emission Tomography
Urinary Bladder
Urinary Bladder Neoplasms
Cisplatin
Doxorubicin

Figure

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  FIG. 1 Contrast-enhanced computed tomography image showing a 3-cm mass on the left lateral side of the urinary bladder. Perivesical invasion was not seen.

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  FIG. 2 An approximately 3-cm sized polypoid mass with a wide stalk on the left lateral wall was visualized by cystoscopy.

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  FIG. 3 The histopathological examination revealed a spindle cell tumor with abundant inflammatory cells in a background consisting of plasma cells, lymphocytes, and polymorphisms with no mitosis, compatible with inflammatory myoblastic tumor of the bladder.

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  FIG. 4 Pathology collected on the third transurethral resection of the bladder tumor revealed proliferation of atypical spindle cells with inflammation, consistent with a myofibroblastic tumor in recurring inflammatory myoblastic tumor. Immunohistochemistry was positive for cytokeratin and vimentin but negative for endomysial antibody.

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  FIG. 5 Abdominopelvic contrast-enhanced computed tomography scan showing an approximately 3.2-cm extruding mass with central necrosis and peripheral enhancement in the anterior wall of the bladder. Multiple lymph node enhancement with a necrotic center in the mesenteric leaf was evident. A subcutaneous nodule was also noted on the right anterior abdominal wall.

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  FIG. 6 Positron emission tomography scan showing multiple lymph node metastases in the left subclavian node and in the right axillary, mediastinum, diaphragm, and common iliac nodes. Multiple soft tissue, bone metastasis, carcinomatosis peritonei, and right pleural metastases were noted.

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  FIG. 7 Endoscopy and colonoscopy findings showed multiple polypoid lesions in the duodenum and entire colon.

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  FIG. 8 Histopathology findings of an extravesical mass with proliferating atypical spindle cells and inflammation, consistent with a myofibroblastic tumor. Immunohistochemistry was positive for endomysial antibody and cytokeratin but negative for smooth muscle actin and anaplastic lymphoma kinase.

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