Neurofibroma of bladder: A case report and literature review

Abstract

To improve the understanding and treatment level of urogenital nerve fibroma by sharing the clinical manifestations, imaging features, and pathological characteristics of a case of urogenital nerve fibroma.The patient was a middle-aged male with initial symptoms of painless gross hematuria, bladder irritation, and pelvic mass. Imaging examination showed a bladder mass, and transurethral bladder tumor resection was performed to reduce the tumor. Pathology was confirmed to be bladder neurofibroma. After 6 months of surgery, follow-up examination showed a significant reduction in tumor volume and no recurrence. The successful diagnostic and therapeutic experience of this case can be referenced for clinical practice.

1 Introduction

Neurofibroma of the genitourinary system is very rare in clinical practice, and neurofibroma of the bladder is the most common organ. Patients often experience clinical symptoms at a young age, with a much higher proportion of male patients than female patients. We report a case of primary neurofibroma of the bladder in a 36-year-old male whose clinical symptoms were clinical symptoms of painless gross hematuria, bladder irritation, and pelvic mass. Pelvic magnetic resonance imaging shows thickening of the right posterior wall of the bladder, with irregular soft tissue signal shadows protruding into the cavity. The prostate and bilateral seminal vesicles are also affected. Through cystoscopy and pathological biopsy, it was found to be consistent with neurofibroma of the bladder. Immunohistochemical examination further confirmed the diagnosis.

2 Case presentation

The patient, a 36-year-old male, presented to our hospital for 2 days due to painless gross hematuria accompanied by lower abdominal pain; The patient has a family history of neurofibroma (his grandmother and father); Physical examination: A cystic mass can be palpated in the bladder area of the lower abdomen, and multiple cystic masses can be palpated along the spine in the lower back ( Fig. 1 A).Multiple coffee-latte spots and subcutaneous soft tissue masses are found on the skin of the whole body ( Fig. 1 B).Urinary tract ultrasound shows a solid cystic mass in the pelvic cavity. Further magnetic resonance imaging of the lumbosacral vertebrae and pelvic cavity revealed enlargement of the sacral canal and some sacral foramen, with a local cystic protrusion towards the pelvic cavity ( Fig. 2 A and B).Nodular shadows were observed in the subcutaneous fat layer of the lumbosacral region, with larger ones ranging from approximately 1.9cm–1.3cm. Thickening of the trigone and right posterior wall of the bladder, with irregular soft tissue signal shadows protruding into the cavity, with a maximum cross-section of approximately 4.6cm × 3.3cm( Fig. 2 C). A cystic shadow can be seen between the posterior wall of the bladder and the sacrum, with a size of approximately 4.9cmX2.9cm. The prostate and bilateral seminal vesicles are enlarged with uneven signals( Fig. 2 D).

3 Treatment and outcome

The patient has persistent symptoms of hematuria and bladder irritation. After admission, the patient underwent transurethral cystoscopy and bladder tumor biopsy; During the operation, a bladder diverticulum was visible on the lateral wall of the bladder, and a solid mass with a wide base was observed on the right posterior wall of the bladder, measuring about 5cmX3cm in size. The surface showed mucosal redness, swelling, and easy bleeding; Clamp the tissue and send it for pathological examination. The pathological results indicate that there is spindle cell proliferation in the stroma (biopsy of bladder tumor), combined with immunohistochemical results, it is considered as neurofibroma.If necessary, NF gene testing can be performed to further clarify neurofibromatosis. Vimentin (+), SOX-10 (+), S100 (+), CK (−), EMA (−), CD21 (−), CD35 (−), CD117 (−), DOG-1 (−), CD34 (vascular+), Bcl-2 (weak+), CD31 (vascular+), CD68 (histiocyte+), Desmin (−), SMA (−), B-catenin (plasma+), Ki67 (3–5%+)( Fig. 3 A–F).