Urogenital Imaging

Leiomyoma, bladder

the commonest benign bladder tumour. Leiomyoma of the bladder usually occurs in females aged 30 - 50 years. It usually arises at the trigone but may be found on the lateral or posterior walls. The dome and anterior bladder wall are infrequent sites. Over 60% project intravesically, but 30% project peripherally from the bladder wall and are extravesical. The remainder have both intra- and extravesical components. The intravesical leiomyoma commonly presents with haematuria and irritative cystitis symptoms. Outlet obstruction due to trigonal leiomyoma at the bladder neck has been reported. Extravesical leiomyomas are usually asymptomatic until they reach a large size and present as a lower abdominal mass.

Intravesical leiomyomas may present as a fixed filling defect within the bladder if the lesion is 1 - 2 cm or more in diameter. Extravesical leiomyoma presents as an extrinsic mass distorting the bladder outline. Transabdominal ultrasound is the most commonly used noninvasive method of assessing bladder lesions (Fig.1). A fixed intravesical mass can be visualized, but cannot be distinguished from other intravesical fixed lesions.

Extravesical leiomyoma is seen as an extrinsic mass and care must be taken to elicit the origin of the mass as that of the bladder wall. It may be difficult to distinguish from uterine leiomyoma. If ultrasound examinations show both an intra- and extravesical component, leiomyoma should be considered in the differential diagnosis, but bladder carcinoma may give a similar appearance, although it is less likely to produce a large extravesical mass. The differential diagnosis of benign neoplasms of the bladder includes leiomyoma, endometriosis, haemangioma, neurogenetic adenoma, neurofibroma and paraganglioma.

HH

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig.1

a. Axial transabdominal ultrasound image of the pelvis, showing a bladder leiomyoma, as indicated by calipers. The tumour appears as a hypoechoic intraluminal filling defect in the bladder. b. Axial CT in the same patient demonstrates the leiomyoma has a bilobed configuration, with both a mural and an intraluminal component. c. Axial T2-weighted MRI section confirms the CT findings, and also shows a small focus of necrosis in the centre of the tumour (arrow).
Leiomyoma, bladder, Fig.1 (a)
Leiomyoma, bladder, Fig.1 (b)
Leiomyoma, bladder, Fig.1 (c)