Camacho-Castro AJ, Sánchez-Turati JG, García-Salcido FJ, Muñoz-Ibarra E, Ahumada-Tamayo S, Fernández-Noyola G, Martínez JA, Pérez-Becerra R, Santana-Ríos ZA, Urdiales-Ortiz A, Fulda-Graue S, Hernández-Castellanos V, Saavedra-Briones D, Merayo-Chalico CE, Recinos-Carrera G, Cantellano-Orozco M, Morales-Montor JG, Pacheco-Gahbler C

Language: Spanish
References: 8
Page: 235-238
PDF size: 465.61 Kb.

ABSTRACT

Introduction: A rare mesenchymatous tumor is reported here with fibroblastic differentiation. In 1931 Kemplerer and Rabin first described its pleuropulmonary localization as benign tumor of the pleura, or fibrous mesothelioma. Its diagnosis is incidental especially in small tumors; in large tumors there is urinary symptomatology with pressure effect. It presents with greater frequency in patients between the fourth and seventh decades of life with a slight predominance in women. Macroscopically fibrotic leiomyoma-type tissue is observed.
Objective: To report a case of solitary fibrous tumor of the bladder.
Clinical case: Patient is a 46-year-old man with no significant past medical history. Illness began ten months prior to hospital admittance with sudden onset of total macroscopic hematuria, painless, and with clotting. Physical examination at the authors’ institution revealed normal vital signs, palpable mass in abdominal hypogastrium of approximately 10 x 10 cm, adhered to deep planes. Laboratory workup: Hb 8.2 g/dL, Ht 23.6%, glucose 127 mg/dL, BUN 44 mg/dL, creatinine 3.14mg/dL, urinalysis: density 1.026, pH 7.0, proteins 60 mg/dL, ketones 15 mg/dL, blood ++++, and innumerable erythrocytes. Hemostatic transurethral resection of the bladder was initially carried out revealing solid bladder tumor occupying entire bladder floor. Extension studies: abdominopelvic computed tomography scan showed bladder tumor occupying entire base, density of 33 and 55 HU with clots in the interior, as well as bilateral ureterohydronephrosis. Bilateral nephrostomy catheters were placed to ensure kidney function. Second transurethral resection of the bladder was then carried out and histopathological study reported: solitary fibrous tumor with 30% necrosis, CD34 (+++), vimentin (++), and S100 (++). Finally total excision of bladder tumor was done and histopathological study reported: 12 x 8.5 x 8 cm benign solitary fibrous tumor with 5% necrosis. Patient is currently under outpatient surveillance at the eighth month of follow-up.
Discussion: There are six cases of solitary fibrous tumor of the bladder reported in the international literature and different management measures were taken in each one, from radical cystectomy to tumorectomy, and up to now there is no established management protocol. The present case was managed satisfactorily with tumorectomy.

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