Year : 2008 | Volume
: 19 | Issue : 2 | Page : 247--249
Recurrent Multifocal Primary Amyloidosis of Urinary Bladder
S Patel, A Trivedi, P Dholaria, M Dholakia, A Devra, B Gupta, SA Shah
Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
S A Shah
Kidneyline Healthcare Pvt Ltd, 1st Floor, Harikrupa Tower, B/h Gujarat College, Ellisbridge, Ahmedabad – 380006, Gujarat
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.
|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;19:247-249
|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 2020 Sep 30 ];19:247-249
Available from: http://www.sjkdt.org/text.asp?2008/19/2/247/39364
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.
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.
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.  Amyloid deposits are localized to the bladder wall with possible involvement of the perivesical ureter. 
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. 
Some non-specific anti-inflammatory agents such as oral colchicine have been reported beneficial in the local bladder amyloidosis.  Diffuse or locally extensive bladder involveement usually requires conventional transurethral resection that should be supplemented with intravesical DMSO instillation. 
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.  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.
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