Leiomyom der Harnblase

Multidetector
computed tomography evaluation of bladder lesions. A 57-year-old female patient with bladder leiomyoma. Axial non-contrast a and contrast-enhanced b CT images showing a smooth homogenous enhancing solid mural mass of the bladder (arrow), similar in appearance to uterine leiomyoma
ejrnm.springeropen.com • CC-by-4.0
An unusual
bladder tumour. A heterogeneous solid lesion was seen in the anterior bladder wall (arrows). This lesion showed regular contour, progressive enhancement, and was surrounded interiorly by a regular line, which continued with the bladder wall (arrowheads).
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Leiomyoma of
the bladder in a 58-year-old woman. The pelvic ultrasonography demonstrates a 30 x 18 mm oval echoic mass with regular limits and discretely heterogeneous structure involving the posterolateral left wall of the bladder with intra and extravesical development.
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Leiomyoma of
the bladder in a 58-year-old woman. This mass is not vascularized on Doppler analysis.
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Leiomyoma of
the bladder in a 58-year-old woman. A smooth-walled mass involving the posterolateral left wall projecting into the bladder lumen, which was hypovascular with only minimal homogeneous enhancement following intravenous contrast.
www.eurorad.org • CC by-nc-sa-4.0
Leiomyoma of
the bladder in a 58-year-old woman. A smooth-walled mass involving the posterolateral left wall projecting into the bladder lumen, which was hypovascular with only minimal homogeneous enhancement following intravenous contrast.
www.eurorad.org • CC by-nc-sa-4.0
Leiomyoma of
the bladder in a 58-year-old woman. A homogeneous smooth mass in the lateral left bladder wall with filling defect.
www.eurorad.org • CC by-nc-sa-4.0
Leiomyoma of
the bladder in a 58-year-old woman. A homogeneous smooth mass in the posterolateral left bladder wall with filling defect.
www.eurorad.org • CC by-nc-sa-4.0
Leiomyoma of
the bladder presenting as acute urinary retention in a female patient: urodynamic analysis of lower urinary tract symptom; a case report. Sagittal section of a magnetic resonance image. Sagittal section of a magnetic resonance image shows a homogeneous mass (2.7 cm in diameter) occupying the area between the bladder neck and the anterior vaginal wall. The tumor mass was homogenously enhanced after the injection of gadolinium.
bmcurol.biomedcentral.com • CC-by-2.0
Leiomyoma of
the urinary bladder • Leiomyoma of the urinary bladder - Ganzer Fall bei Radiopaedia
Ashraf A, Leiomyoma of the urinary bladder. Case study, Radiopaedia.org (Accessed on 23 Nov 2023) https://doi.org/10.53347/rID-86953 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumor of the bladder. The most common presenting complaints are urinary voiding symptoms such as obstruction and irritation.

These leiomyomas exhibit imaging characteristics on ultrasound, CT and MRI similar to those of uterine leiomyomas: a well-marginated homogeneous solid mass.

Epidemiology

Leiomyomas are the most common benign bladder neoplasm but account for only 0.4% of all bladder tumors. They occur equally in men and women with a broad age range of 22-78 years . Approximately 75% of the patients are young and middle-aged .

Clinical presentation

Most are small and asymptomatic and are discovered incidentally. However, large tumors manifest with symptoms such as :

  • hesitancy, frequency, dribbling
  • hematuria
  • pressure from mass effect
  • urinary obstruction

Pathology

It is a non-infiltrative smooth muscle tumor lacking mitotic activity, cellular atypia, and necrosis. Leiomyomas arise in the submucosa, but growth may be submucosal (7%), intravesical (63%), or extravesical (30%). At cystoscopy, normal bladder mucosa covers the leiomyoma.

Radiographic features

Imaging features include either a smooth indentation of the bladder wall or an intraluminal mass. The lesions are smooth, solid, homogeneous masses. Cystic components indicate degeneration. The tumor exhibits characteristics similar to those of their uterine counterpart at US, CT, and MR imaging, with MR imaging being most accurate for tissue characterization.

Ultrasound
  • US examination typically shows a smooth-walled homogeneous hypoechoic solid mass in the bladder with thin echogenic surface
  • with US it is possible to determine the endovesical, intramural or extravesical nature of the lesion
CT
  • CT is accurate in detection and localization of these lesions, and it presents as a hypoattenuating mass  
  • with contrast administration the leiomyoma shows moderate enhancement
MRI

MRI is superior in demonstrating the submucosal origin of the tumor and the preservation of the muscle layer. The imaging characteristics are similar to uterine leiomyomas:

  • T1:
    • intermediate signal intensity 
  • T2:
    • low signal intensity  
    • degenerated leiomyomas have more heterogeneous signal characteristics; cystic areas have high signal intensity
  • T1 C+ (Gd):
    • contrast enhancement is variable; degenerated areas lack enhancement

Treatment and prognosis

Focal excision of the mass is the treatment of choice. A preoperative suspicion of a leiomyoma is invaluable in alerting the surgeon to the benign nature of the mass and preventing unnecessary radical surgery .

Differential Diagnosis

A pedunculated intraluminal leiomyoma may be confused with a urothelial lesion or urothelial cell carcinoma of the bladder but a leiomyoma should be of lower signal intensity on T2-weighted images .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Leiomyom der Harnblase:
Leiomyofibrom
Uterus
Wikipedia • CC BY-SA 4.0
Neoplasien
der Blase
ejrnm.springeropen.com • CC-by-4.0
benigne
Tumoren der Harnblase
www.eurorad.org • CC by-nc-sa-4.0
Leiomyosarkom
der Harnblase
ejrnm.springeropen.com • CC-by-4.0