Académique Documents
Professionnel Documents
Culture Documents
@
pica asintomática. La cistoscopia revela la presencia de
una lesión sésil rojiza de 1 cm de diámetro próxima al cue-
llo vesical. Realizamos una resección transuretral utilizando
CORRESPONDENCE un resectoscopio bipolar Gyrus®. El estudio anatomopato-
lógico reveló un hemangioma cavernoso.
CONCLUSIÓN: Los hemangiomas vesicales son lesiones
Octavio Castillo benignas de baja incidencias. Si bien no existen caracte-
Unidad de Urología rísticas clínicas especificas para esta patología, la hema-
Clínica Indisa turia suele ser el signo clínico más frecuente. El manejo es
Av. Apoquindo 3990, Of. 809 controversial principalmente debido a su gran vasculariza-
ción y el consecuente riesgo de sangrado intraoperatorio.
Las Condes Para lesiones de pequeño tamaño la resección transuretral
P.O.: 7550112 Santiago, (Chile) representa una buena alternativa.
octavio.castillo@indisa.cl
Accepted for publication: October 13th, 2010 Palabras clave: Hemangioma vesical. Tratamiento
endoscópico.
624
O. A. Castillo, A. Foneron, F. Sepúlveda, et al.
INTRODUCTION of the patients are younger than 15 years old (1, 2, 3).
Hemangiomas are classified into cavernous, capillary
Hemangioma is a benign tumor which accounts for and arteriovenous, being cavernous the most common
0.6% of bladder lesion (1, 2). It has no clear gender (2). Patients present with intermittent gross painless
or age predilection and it often presents with gross hematuria, irritative voiding symptoms, obstructive
painless hematuria. Management is controversial due symptoms, abdominal pain and painful ejaculation (1,
the bleeding risk, and numerous therapeutic options 2). Usually bladder hemangiomas presents as isolated
are described in the literature. We present a case small lesions, although up to 30% of cases presents
of a bladder hemangioma resolved using bipolar in association with cutaneous or visceral vascular
transurethral resection. malformations, being the most common localizations
anus, vulva, buttocks, vagina, labia, scrotum, penis,
lower abdomen and thigh. Hemangiomas could present
CASE REPORT in the context of Klippel-Trenaunay or Sturge Webber
syndrome (2), with cutaneous hemangiomas, varicose
Previously healthy 55 year old female patient consults for veins, and hypertrophy of the involved extremity (3). Up
total painless hematuria. Cistoscopic evaluation reveals to 3 to 6% of patients with Klippel-Trenaunay syndrome
a 1 cm diameter sessile reddish raised lesion near the have bladder hemangiomas. Therefore, complete
bladder neck. We performed a transurethral endoscopic urologic evaluation is recommended in this syndrome
resection using Gyruss Bipolar resectoscope® and a (1, 3).
urethral catheter was left. Postoperatory period was
uneventful, and patient was discharged at the next day This lesion has a benign course and usually presents as
from the surgery without urethral catheter. Pathologic an incidental finding during work up for hematuria or
report concluded mature urothelium with reparative voiding symptoms. Endoscopic findings are non specific
hyperplasia with a lamina propria presenting marked (2) although the presence of a sessile, blue, raised
edema, hyperemia and vascular proliferation, partly mass in a young patient who presents with hematuria
of venous type of wall, partly arterial muscular wall, is highly suggestive of a bladder hemangioma (2).
located mainly in the lamina propria of the mucosa, Endoscopic differential diagnosis for raised pigmented
compatible with a cavernous angioma. lesions includes endometriosis, melanoma and sarcoma
and therefore accurate diagnosis requires confirmation
by biopsy, although it carries a high possibility of
DISCUSSION uncontrollable bleeding (2). Intravenous pyelography,
ultrasonography and computed tomography could be
Hemangiomas are very rare primary bladder lesions, helpful in defining the extent and localization of the
accounting for 0.6% of its tumors. tumor (1, 2). Cystoscopy, as we mentioned earlier,
could show a sessile, broad based lobulated mass with
This benign congenital lesion has no predilection for bluish red color, usually pedunculated (1). Sixty-six
gender or age, but is most common in white men and 65% percent of the lesions are solitary and located on the
FIGURE 1. Cistoscopic view. FIGURE 2. Great vessels with wide lumen, of the venous
type, covered by mature endothelium on the lamina
propria. HE 10x.
625
BLADDER HEMANGIOMA: CASE REPORT
CONCLUSION
FIGURE 3. Wide vessels, with thick walls in the lamina Bladder hemangiomas are benign and rare lesions.
propria of the mucosa with features of cavernous Clinical presentation has no patognomonic signs
hemangioma. although gross painless hematuria is the most frequent
complain. Management is controversial due to the
bleeding risk of this high vascularized lesion. However,
it appears that small lesion could be treated using
transurethral resection. Although it has a benign course,
dome or trigone and 34% are multicentric. Lesions are follow up is mandatory to detect recurrence or residual
rarely located at the bladder neck or ureteral orifices disease.
(1, 2). Occasionally the tumors extend outside the
bladder and may invade other pelvic organs, condition
known as pelvic angiomatosis (1). Its association with
transitional cell carcinoma is rare. REFERENCES AND RECOMMENDED READINGS
(*of special interest, **of outstanding interest)
Treatment is indicated because of the recurrent
hematuria but, due to the bleeding risk, management *1. Leonard M, Nickel J, Morales A. Cavernous heman-
is controversial and numerous therapeutic approaches giomas of the bladder in the pediatric age group. J
are described in the literature (2, 4). Urol, 140 (6):1503, 1988.
**2. Cheng L, Nascimento A, Neumann R, Nehra A,
Biopsy and fulguration, transurethral resection (TUR),
Cheville JC, Ramnani DM, et al. Hemangioma of
partial or complete cistectomy, sclerosing agent
the urinary bladder. Cancer, 1;86(3):498,1999.
injections, irradiation, systemic steroids, interferon
3. Smith J, Dixon J. Neodymium: YAG laser irra-
alpha therapy and Nd: Yag laser are therapeutic
options (2). Partial cistectomy is the recommended diation of bladder hemangioma. Urol, 24(2):134,
treatment for surgically accessible lesions (3). On the 1984.
other hand, TUR has the risk of uncontrollable bleeding 4. Proca E. Haemangioma of the bladder. Br J Urol,
(3, 5), however in a report of the Mayo Clinic (2), with 49(1):60, 1977.
19 patients, biopsy and fulguration of small lesions 5. Susset J, Korzinstone C, Masse S. Cavernous he-
(<3 cm) does not create a significant bleeding and mangioma of vesical neck. Urol, 17(1):75, 1981.
appears to treat this lesions adequately, as well as 6. Gottesman J, Seale R. Cavernous haemangioma of
lesions located in the female bladder neck. Having this the bladder.” Br J Urol, 55(4):450, 1983.