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XANTHOMA OF THE BLADDER ASSOCIATED WITH TRANSITIONAL CELL CARCINOMA
0022-5347/00/1644-1303/0 THE JOURNAL OF UROLOGY® Copyright © 2000 by AMERICAN UROLOGICAL ASSOCIATION, INC.®
Vol. 164, 1303–1304, October 2000 Printed in U.S.A.
XANTHOMA OF THE BLADDER ASSOCIATED WITH TRANSITIONAL CELL CARCINOMA ANTIGONE SKOPELITOU, ANTIGONE MITSELOU
AND
GEORGIA GLOUSTIANOU
From the Department of Pathology, Ioannina University Medical School, Ioannina, Greece KEY WORDS: bladder; xanthomatosis; carcinoma, transitional cell
We report a case of xanthoma and transitional cell carcinoma of the bladder discovered incidentally during routine cystoscopy for hematuria. Xanthoma is rare in the bladder with only 8 cases reported previously. Of these cases 6 were reported in the Japanese literature. Interestingly, the coexistence of xanthoma and carcinoma has been reported only once in association with a diverticulum of the bladder. Since many bladder xanthomas may either be discovered incidentally or complicate a bladder tumor, followup cystoscopy should always be considered.
resection was performed and histopathological findings were xanthoma adjacent to superficially invasive grade II transitional cell carcinoma (fig. 1). The lamina propria had been entirely replaced by closely packed polygonal cells with distinct cell membrane. The nuclei were relatively uniform, small and round to oval, with inconspicuous nucleoli. The cytoplasm was clear to finely granular (fig. 2). No mitotic figures were found. There were no associated inflammatory, giant cells, Michaelis-Gutman inclusion bodies or granuloma formation.
CASE REPORT
DISCUSSION
A 65-year-old man presented with a recent history of hematuria, dysuria and lower abdominal pain. Physical examination did not reveal any disease or dermatological signs. Hematological and biochemical evaluations were normal, and urine culture was negative. Digital rectal examination revealed homogeneous benign prostatic hyperplasia. Prostate specific antigen was normal. There was no history of skin xanthomas, diabetes mellitus, liver disease, hyperlipidemia or hypothyroidism. Furthermore, the patient did not mention any bladder surgery, trauma or inflammation. At cystoscopy a 1.8 ⫻ 2 cm. nodular, velvety yellowish lesion was found to the left of the trigone. Transurethral
Xanthomas are nonneoplastic, reactive tumor-like processes, usually arising in response to disturbances in serum lipids.1–3 They represent a localized collection of tissue histiocytes containing lipid.1–3 Xanthomas may occur in essential hyperlipidemia, disease states associated with secondary hyperlipidemia, for example primary biliary cirrhosis, diabetes mellitus and occasionally the normolipidemic state.1–3 They can also occur as part of many tumors and inflammatory processes, and be related to previous trauma or surgery, as has been hypothesized for gastric xanthoma.3 A localized
Accepted for publication May 26, 2000.
FIG. 1. Polypoid lesion consisting of bladder xanthoma (arrow), FIG. 2. Superficially invasive grade 2 transitional cell carcinoma. adjacent to superficially invasive transitional cell carcinoma. H & E, Inset shows closely packed foamy histiocytes in lamina propria. H & reduced from ⫻85. E, reduced from ⫻120. 1303
1304
BLADDER XANTHOMA ASSOCIATED WITH TRANSITIONAL CELL CARCINOMA
disturbance in lipid metabolism in the mucosa would probably explain their development.1 On the other hand, it has been suggested that endothelial, stromal, histiocytic and, rarely, epithelial cells may be transformed into xanthoma cells.1 From the literature review, including our case, it seems that bladder xanthomas have occurred slightly more often in men than in women.3 The main clinical symptoms were hematuria and lower abdominal pain. However, 4 patients were asymptomatic, 4 were hyperlipidemic, 2 were normolipidemic and 3 had a history of urinary tract infection. In 4 of 6 patients xanthoma was an incidental finding during routine cystoscopy several years after bladder surgery for transitional cell carcinoma. The coexistence of xanthoma and carcinoma in a bladder diverticulum has been reported.2 To our knowledge we report the first case in the English literature of bladder xanthoma that developed adjacent to
transitional cell carcinoma in a normolipidemic patient with no history of local surgical intervention, trauma or inflammation. It is noteworthy that 6 of the 8 bladder xanthoma cases have been reported in the Japanese literature.3 Although the pathogenesis of peritumoral xanthomas has not yet been established, xanthoma and transitional cell carcinoma may coexist, and awareness of this condition may aid in the interpretation of biopsy as has been suggested for xanthogranulomas.2 REFERENCES
1. Miliauskas, J. R.: Bladder xanthoma. Histopathology, 21: 177, 1992 2. Sholl, A. J.: Xanthoma and carcinoma in a diverticulum of the urinary bladder. J Urol, 52: 305, 1944 3. Nishimura, K., Nozawa, M., Hara, T. et al: Xanthoma of the bladder. J Urol, 153: 1912, 1995
Vol. 164, 1303–1304, October 2000 Printed in U.S.A.
XANTHOMA OF THE BLADDER ASSOCIATED WITH TRANSITIONAL CELL CARCINOMA ANTIGONE SKOPELITOU, ANTIGONE MITSELOU
AND
GEORGIA GLOUSTIANOU
From the Department of Pathology, Ioannina University Medical School, Ioannina, Greece KEY WORDS: bladder; xanthomatosis; carcinoma, transitional cell
We report a case of xanthoma and transitional cell carcinoma of the bladder discovered incidentally during routine cystoscopy for hematuria. Xanthoma is rare in the bladder with only 8 cases reported previously. Of these cases 6 were reported in the Japanese literature. Interestingly, the coexistence of xanthoma and carcinoma has been reported only once in association with a diverticulum of the bladder. Since many bladder xanthomas may either be discovered incidentally or complicate a bladder tumor, followup cystoscopy should always be considered.
resection was performed and histopathological findings were xanthoma adjacent to superficially invasive grade II transitional cell carcinoma (fig. 1). The lamina propria had been entirely replaced by closely packed polygonal cells with distinct cell membrane. The nuclei were relatively uniform, small and round to oval, with inconspicuous nucleoli. The cytoplasm was clear to finely granular (fig. 2). No mitotic figures were found. There were no associated inflammatory, giant cells, Michaelis-Gutman inclusion bodies or granuloma formation.
CASE REPORT
DISCUSSION
A 65-year-old man presented with a recent history of hematuria, dysuria and lower abdominal pain. Physical examination did not reveal any disease or dermatological signs. Hematological and biochemical evaluations were normal, and urine culture was negative. Digital rectal examination revealed homogeneous benign prostatic hyperplasia. Prostate specific antigen was normal. There was no history of skin xanthomas, diabetes mellitus, liver disease, hyperlipidemia or hypothyroidism. Furthermore, the patient did not mention any bladder surgery, trauma or inflammation. At cystoscopy a 1.8 ⫻ 2 cm. nodular, velvety yellowish lesion was found to the left of the trigone. Transurethral
Xanthomas are nonneoplastic, reactive tumor-like processes, usually arising in response to disturbances in serum lipids.1–3 They represent a localized collection of tissue histiocytes containing lipid.1–3 Xanthomas may occur in essential hyperlipidemia, disease states associated with secondary hyperlipidemia, for example primary biliary cirrhosis, diabetes mellitus and occasionally the normolipidemic state.1–3 They can also occur as part of many tumors and inflammatory processes, and be related to previous trauma or surgery, as has been hypothesized for gastric xanthoma.3 A localized
Accepted for publication May 26, 2000.
FIG. 1. Polypoid lesion consisting of bladder xanthoma (arrow), FIG. 2. Superficially invasive grade 2 transitional cell carcinoma. adjacent to superficially invasive transitional cell carcinoma. H & E, Inset shows closely packed foamy histiocytes in lamina propria. H & reduced from ⫻85. E, reduced from ⫻120. 1303
1304
BLADDER XANTHOMA ASSOCIATED WITH TRANSITIONAL CELL CARCINOMA
disturbance in lipid metabolism in the mucosa would probably explain their development.1 On the other hand, it has been suggested that endothelial, stromal, histiocytic and, rarely, epithelial cells may be transformed into xanthoma cells.1 From the literature review, including our case, it seems that bladder xanthomas have occurred slightly more often in men than in women.3 The main clinical symptoms were hematuria and lower abdominal pain. However, 4 patients were asymptomatic, 4 were hyperlipidemic, 2 were normolipidemic and 3 had a history of urinary tract infection. In 4 of 6 patients xanthoma was an incidental finding during routine cystoscopy several years after bladder surgery for transitional cell carcinoma. The coexistence of xanthoma and carcinoma in a bladder diverticulum has been reported.2 To our knowledge we report the first case in the English literature of bladder xanthoma that developed adjacent to
transitional cell carcinoma in a normolipidemic patient with no history of local surgical intervention, trauma or inflammation. It is noteworthy that 6 of the 8 bladder xanthoma cases have been reported in the Japanese literature.3 Although the pathogenesis of peritumoral xanthomas has not yet been established, xanthoma and transitional cell carcinoma may coexist, and awareness of this condition may aid in the interpretation of biopsy as has been suggested for xanthogranulomas.2 REFERENCES
1. Miliauskas, J. R.: Bladder xanthoma. Histopathology, 21: 177, 1992 2. Sholl, A. J.: Xanthoma and carcinoma in a diverticulum of the urinary bladder. J Urol, 52: 305, 1944 3. Nishimura, K., Nozawa, M., Hara, T. et al: Xanthoma of the bladder. J Urol, 153: 1912, 1995