Submucosal cystic neurofibroma of the bladder- A case report

Abstract

50 year old male, farmer by occupation
presented with dysuria and urinary incontinence
3months duration, hematuria 2
episodes, only in the initial stream,
painless, no passage of clots or tissue
bits. Abdominal examination was normal
with no organs or mass palpable. Digital
rectal examination revealed grade 1
prostatic enlargement and above prostate,
there was large boggy mass , superior
extent could not be felt . Routine biochemical
and hematological investigation
revealed raised renal parameters. Urine
routine examination was normal. Urine
culture revealed - no growth. Urine cytology
- negative for malignancy. Chest x
ray is normal. USG study, showed multiloculated
mixed echogenic mass appearing
within bladder. Both kidneys showed
hydroureteronephrosis. Suprapubically
usg guided trucut biopsies from the mass
done twice- were negative for malignancy.
Plain CT abdomen and pelvis
done previously showed heterodense
lesions inside the bladder both anterior
and posteriorly,
with peri vesical extension posteriorly.
Antegrade study showed multiple filling defects
inside the bladder. MRI pelvis showed
hetero intense mass lesion, soft tissue
component predominantly in posterior aspect,
and multiple cystic components filling
rest of the bladder, both ureteric orifices
encroached by the mass. Initially right percutaneous
nephrostomy (pcn) was done,
left pcn done subsequently because of persistently
elevated renal parameters. Cystoscopy
revealed normal bladder mucosa ,
with indendations seen - (right) lateral wall,
(right) anterior wall, and in the posterior
wall midline above trigone, (right) ureteric
orifice could not be visualised. Trans urethral
resection biopsy - possibility of benign
leiomyoma. Surgery through lower abdominal,
extraperitoneal approach. Bladder was
opened. Tumour found to be intramucosal,
pedunculated arising from the base of the
bladder, mostly from the right side, involving
right ureteric orifice also. Entire tumour
was resected and right ureteric reimplantation
done . Post operative histopathology -
sub mucosal cystic neurofibroma. The case
is presented for its rarity.