Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 2026 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 2  |  Page : 247-249
Recurrent Multifocal Primary Amyloidosis of Urinary Bladder


Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India

Click here for correspondence address and email
 

   Abstract 

Primary localized amyloidosis of bladder is rare. We report a case of recurrence of multifocal primary amyloidosis of urinary bladder. Cystoscopy revealed a diffuse left lateral wall lesion with normal surrounding mucosa. Histopathological examination of the specimen revealed urinary bladder amyloidosis with negative surgical margins. Recurrent urinary bladder amyloidosis was confirmed 3 months after the first resection. Close follow-up is recommended.

Keywords: Urinary, Bladder, Recurrent, Amyloidosis

How to cite this article:
Patel S, Trivedi A, Dholaria P, Dholakia M, Devra A, Gupta B, Shah S A. Recurrent Multifocal Primary Amyloidosis of Urinary Bladder. Saudi J Kidney Dis Transpl 2008;19:247-9

How to cite this URL:
Patel S, Trivedi A, Dholaria P, Dholakia M, Devra A, Gupta B, Shah S A. Recurrent Multifocal Primary Amyloidosis of Urinary Bladder. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Nov 22];19:247-9. Available from: http://www.sjkdt.org/text.asp?2008/19/2/247/39364

   Introduction Top


Primary localized amyloidosis of bladder is rare with 166 cases reported in literature since its initial description by Solomin in 1987. Recurrence is common in primary urinary bladder amyloidosis. We report a case of recurrence of multifocal primary amyloidosis of urinary bladder.


   Case Report Top


A 38-year-old man initially presented with symptoms of dysuria, occasional urgency, and hematuria in January 2006. Urinalysis revealed hematuria, however, cytology of urine was unremarkable. Intravenous uro­graphy revealed irregularity at bladder base with no upper tract changes. Cystoscopy revealed a diffuse left lateral wall lesion with normal surrounding mucosa. The lesion was around 3 x 3 cm mass well away from left ureteric orifice. Transurethral resection was performed, and histopathological examination of the specimen revealed urinary bladder amyloidosis with negative surgical margins. The patient was advised to undergo evalua­tion to rule out systemic amyloidosis. How­ever, he was lost to follow-up.

After 3 months the patient presented with recurrent hematuria. However, the radio­graphic studies were unremarkable. Cystos­copy demonstrated yellowish submucosal 2 x 2 cm nodules at the lateral and anterior walls with normal surrounding mucosa. Transurethral resection was performed. The presence of amorphous eosinophilic deposits that stained positive with congo red on the histological examination of the specimen diagnosed the recurrent urinary bladder amyloidosis [Figure - 1],[Figure - 2]. The patient was subjected to systemic evaluation for amyloidosis including rectal biopsy, abdo­minal and heart sonography, retinal exami­nation, serum electrophoresis, and Bence Jones protein. No evidence of systemic amyloidosis was found.

We prescribed the patient oral colchicine 2 mg bid and intravesical dimethyl sulfoxide (DMSO). Follow-up included an annual cystoscopy and a computed tomography scan every 2 years. The cystoscopy at the end of 1 year of follow-up did not reveal any evidence of recurrence.


   Discussion Top


Primary amyloidosis of urinary bladder is a rare condition but recurrence is quite common. Amyloidosis of bladder presents a great challenge to the urologist because of its close resemblance with an infiltrating neoplasm of bladder. The right lateral wall of the bladder is more commonly affected than the trigone or anterior wall. [1] Amyloid deposits are localized to the bladder wall with possible involvement of the perivesical ureter. [2]

Patients usually need prompt evaluation as in our index case in order to rule out systemic amyloidosis, which requires different management and has worse prognosis. [3]

Some non-specific anti-inflammatory agents such as oral colchicine have been reported beneficial in the local bladder amyloidosis. [4] Diffuse or locally extensive bladder involve­ement usually requires conventional trans­urethral resection that should be supple­mented with intravesical DMSO instillation. [5]

Tirzman followed up 24 patients with loca­lized bladder amyloidosis from 2 to 36 years; 25 % remained disease free, 21% had stable lesions and 54% recurred. No recurrence was observed after 3 years of disease-free interval. [6] However, some lesions recurred after 6 years of follow-up.

Annual cystoscopy is recommended, and a pelvic CT scan is advisable biannually to identify early submucosal recurrence. Our patient remained disease-free at 1 year follow-up.

We conclude that primary urinary bladder amyloidosis is a rare and recurrent disease. It can present as a multifocal lesion. Life-long surveillance is mandatory. Intravesical DMSO and oral colchicine are beneficial adjunctive therapy to resection of the lesion.

 
   References Top

1.Gupta NP, Yadav SP, Safaya R. Primary amyloidosis of urinary bladder. Indian J Urol 1993;10(1):11-3.  Back to cited text no. 1    
2.Ferch R, Haskell R, Farebrother T. Primary amyloidosis of the urinary bladder and ureters. Br J Urol 1997;80(6):953-4.  Back to cited text no. 2    
3.Hinsch R, Thompson L, Conrad R. Secondary amyloidosis of the urinary bladder: A rare cause of massive heamaturia. Aust NZ J Surg 1996;66(2):127-8.  Back to cited text no. 3    
4.Livingstone RR, Sarembock LA, Barnes RD, Folb PI. Colchicine therapy in primary amyloidosis of the bladder: A case report. J Urol 1989;142(6):1570-1.  Back to cited text no. 4    
5.Malek RS, Wahner-Roedler DL, Gertz MA, Kyle RA. Primary localized amyloidosis of the bladder: Experience with dimethyl sulfoxide therapy. J Urol 2002;168(3):1018-­20.  Back to cited text no. 5    
6.Tirzaman O, Wahner-Roeder DL, Malek RS, Swbo TJ, Li CY, Kylew RA. Primary localized amyloidosis of the urinary bladder: A case series of 31 patients. Mayo Clin Proc 2000;75(12):1264-8.  Back to cited text no. 6    

Top
Correspondence Address:
S A Shah
Kidneyline Healthcare Pvt Ltd, 1st Floor, Harikrupa Tower, B/h Gujarat College, Ellisbridge, Ahmedabad – 380006, Gujarat
India
Login to access the Email id


PMID: 18310877

Rights and Permissions


    Figures

  [Figure - 1], [Figure - 2]

This article has been cited by
1 Amyloidosis of the unilateral renal pelvis, ureter and urinary bladder: A case report
Pan, D.-L. and Na, Y.-Q.
Chinese Medical Sciences Journal. 2011; 26(3): 197-200
[Pubmed]
2 Urology: What is your diagnosis? [Urologie: Wie lautet ihre diagnose?]
Markart, P. and Diener, P.-A. and Schmid, H.-P.
Praxis. 2011; 100(7): 403-404
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

 Article Access Statistics
    Viewed3951    
    Printed88    
    Emailed0    
    PDF Downloaded429    
    Comments [Add]    
    Cited by others 2    

Recommend this journal