Spindle Cell Neoplasm of the Urinary Bladder in a Young Male: A Rare Case

Abstract

Case report: A 28‐year‐old male with no significant past medical history presented to the Emergency Department with clot retention and hypovolaemic shock. Emergency TURBT revealed a large solid bladder mass which was resected down to muscle. The patient initially had macroscopic haematuria and presented to their general practitioner in May 2018 who organised an ultrasound demonstrating a 33 mm bladder lesion. Histology from the TURBT revealed a spindle cell neoplasm. mmunohistochemistry of the tumour was positive for ALK, SMA, desmin, CK8/18 and AE1/3, stains indicative for an inflammatory myofibroblastic tumour. Discussion at multi‐disciplinary team meeting resulted in decision for regular endoscopic surveillance of his bladder. Discussion: Spindle cell malignancies are a rare but distinct disease entity. They can occur in all age groups, at any anatomic location and predominantly occur in males. Important microscopic characteristics of spindle cell neoplasm including intersecting fascicles of spindle cells, small blood vessels and various chronic inflammatory cells scattered in myxoid stroma. They are usually arranged in bundles and have numerous mitotic figures without any significant atypia. There are currently 21 cases in the literature. Patient age ranged from 40 to 85 years and males were affected 1.6× more than females (4). Majority of patients presented with haematuria (66%) with lesions ranging in size between 0.4 and 4.5 cm (mean 2.0 cm) (4). Out of the 21 patients in the literature, majority of patients were managed locally by endoscopic resection. Follow up data was available for 20 patients and demonstrated no tumour recurrence or metastasis in 17 patients (4). Due to the good postoperative follow‐up results, the best choice for patients with spindle cell malignancy of the bladder is endoscopic resection, while radical treatment appears to be excessive and unnecessary.