Intravesical protrusion of retropubic osteophyte mimicking a urinary bladder tumour

di Pierro-Giovanni, B.; Danuser, H.; Mattei, A.

doi:10.1016/j.acuroe.2011.10.006

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Joint damages are caused by a mixture of systemic factors (genetic inheritance, age, etc.) that predispose to the disease and local mechanism (cartilage lost, bone remodeling, osteophyte formation, etc.) that dictate its distribution and severity. Various genetic abnormalities have been described, but most sporadic osteoarthritis probably depends on minor contributions from several genetic loci. Osteoarthritic joint damages may be associated with clinical symptoms, but the severity of joint disease is only weakly related to that of the clinical problems.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>We recently observed a 66-year-old man presenting to our department with a history of macrohaematuria, which occurred intermittently during the previous 2 months in absence of any other sign or symptom. The patient denied recent genitourinary traumas, surgery, infections, previous bladder cancer history or anticoagulant therapy. He underwent retropubic radical prostatectomy 9 years earlier and the actual PSA value was <0.01ng/ml. Physical examination was negative. On urinary cytology, no malignant urothelial cells were identified and the urine culture revealed only erythrocytes and leucocytes, without evidence of infection. Pelvic ultrasonography showed a 3.2cm×2.0cm large endoluminal mass located on the anterior bladder wall. Subsequent cystoscopy confirmed this bulge projecting into the vesical lumen, and CT scan of abdomen-pelvis showed a filling defect of the anterior bladder wall due to posterior symphyseal osteophyte secondly involving the urinary bladder (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No treatment was necessary, no further investigation was performed, and the patient was healthy with no signs or symptoms after a 10-month follow-up.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In fact, haematuria is the most common finding in bladder tumours. Usually, diagnostic tools include urine cytology, ultrasonography, and cystoscopy with description of the tumour (site, size, number and appearance) and further mucosal abnormalities. Intravenous urography (IVU) or CT of abdomen and pelvis is also performed in selected cases (tumours located in the trigone). However, a transurethral resection of the bladder tumours is essential to make a correct diagnosis and remove all visible lesions.Differential diagnosis between primary bladder tumours and further diseases can be required: in the literature, benign or malignant entities, such as gastronintestinal carcinoma<a class="elsevierStyleCrossRef" href="#bib0010">2</a> or focal infolding of normal mucosa,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> secondly involving the bladder or mimicking a bladder neoplasm, are already described.To our knowledge, this is the first report describing an osteophyte from the pubic symphysis presenting as a mass causing vesical impression and mimicking a bladder tumour. Therefore, osteophyte of the pubic symphysis has to be considered also when performing the abovementioned differential diagnosis. In fact, several pathologic processes can involve the symphysis, including infectious, congenital, metabolic, inflammatory, traumatic, and degenerative diseases. The most frequently occurring symptoms are pain and discomfort, and treatment is most often conservative.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>In our case, the only sign complained by the patient was the macroscopic haematuria. On the other hand, in presence of macroscopic haematuria, the finding of an intraluminal vesical mass usually leads to perform cystoscopy and a TUR or at least a biopsy, but, in our experience, recognizing the non-neoplastic nature of the lesion enabled us to avoid not required surgical procedures. This suggests that sometimes imaging examinations can be decisive to exclude primary/secondary vesical neoplasms or distinguish between malignant and benign disorders involving the bladder, in order to avoid further unnecessary procedures." 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Actas Urol Esp. 2012;36:446–7." ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 792 "Ancho" => 952 "Tamanyo" => 95358 ] ] "descripcion" => array:1 [ "en" => "CT-scan of abdomen-pelvis showing a filling defect on the anterior bladder wall due to the symphyseal osteophyte." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis and management of pain in osteoarthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.A. Dieppe" 1 => "L.S. Lohmander" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)71086-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "365" "paginaInicial" => "965" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15766999" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Signet ring cell carcinoma of a pulled-through sigmoid colon mimicking a primary invasive bladder tumor: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.T. Posey" 1 => "E.Z. Neulander" 2 => "M.S. Soloway" 3 => "F. Civantos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Urology" "fecha" => "2000" "volumen" => "55" "paginaInicial" => "949" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10840481" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pseudomass of the bladder neck after prostatectomy: report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.J. Halpern" 1 => "L.G. Gomella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2263020255" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2003" "volumen" => "226" "paginaInicial" => "833" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12601184" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003600000007/v1_201304251927/S2173578612001813/v1_201304251927/en/main.assets" "Apartado" => array:4 [ "identificador" => "6306" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003600000007/v1_201304251927/S2173578612001813/v1_201304251927/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612001813?idApp=UINPBA00004N"]

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Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

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Vol. 36. Issue 7.

Pages 446-447 (July - August 2012)

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