Primary Localised Urinary Bladder Amyloidosis: A Mimicker of Malignancy

Abstract

Aim: To study clinical features of primary urinary bladder amyloidosis, to identify it, to differentiate it from urinary bladder malignancy and to treat the disease. Case Presentation: We present a case of 51-year-old gentleman presented with painless gross hematuria who was a known case of Nonalcoholic SteatoHepatitis (NASH) associated chronic liver disease. Ultrasound revealed a large blood clot without any evidence of mass or lesion. Cystoscopy revealed a flat lesion near trigone and biopsied. Lesion completely respected and surprisingly histopathology turned out to be localised amyloidosis which was confirmed with immunohistochemistry (IHC) profile. Within 6 months patients had recurrence and repeat trans urethral resection was performed. After that patients remained asymptomatic for 18 months and still under follow up without recurrence. Discussion: The aetiology of bladder amyloidosis is poorly understood. There are two different schools of thoughts. Most researchers think that it is abnormal metabolism of protein which causes amyloidosis. While others think that it is a sequela of chronic urinary tract infection or repeated inflammation of mucosa and submucosa. Investigation protocol includes basic blood investigations, urine for cytology, ultrasound and CT-IVP and cystoscopic resection and Histopathological examination conclude the diagnosis. As the recurrence is known phenomenon, strict cystoscopic follow up is necessary. Conclusion: Primary urinary bladder amyloidosis mimics bladder malignancy clinically. Thus, it is of utmost importance to distinguish between both of them and to treat them accordingly.