Journal of Surgical Oncology 24: 142-144 (1983)

Hemangioma of the Urinary Bladder

DEBA P. SARMA, Mi), ANU MARSHALL WEINER, Mi)

From the Department of Pathology, Louisiana State University Medical School, the Department of Urology, Tulane School of Medicine, and Veterans Administration

M e d i d Center, New Orleans

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A hemangioma of the urinary bladder occurring in a 66-year-old man is described. Although hemangioma is a common lesion in many parts of the body, it remains a very rare primary tumor in the bladder. Clinically the patient usually presents with recurrent hematuria, control of which may necessitate a segmental cystectomy .

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KEY WORDS: hemangioma, bladder hemangioma, rare tumor of bladder

INTRODUCTION Hemangiomas have been known to involve idmost

every organ of the body. However, hemangioma of the bladder is a very rare occurrence. The purpose of this paper is to report such a case and to briefly review the literature.

CASE REPORT A 66-year-old black man presented with symptoms of

lower urinary tract obstruction. The patient on question- ing also complained of painless hematuria occurring in- termittently over the past one year. He did not report to any physician because on each occasion the urine promptly cleared. Physical examination was unremark- able including absence of any cutaneous hemangioma. Intravenous pyelogram revealed no lesions of the kidneys or ureters. Cystoscopic examination revealed prostatic obstruction with moderate trabeculation of the bladder mucosa. Biopsy of several small areas of red, velvety tissue showed chronic cystitis. A 5-mm, slightly ele- vated, pink lesion on the trigone was also biopsied, revealing a capillary hemangioma (Fig. 1).

There was no significant bleeding from the biopsy site. The patient later underwent a transurethral resection of the prostate that revealed benign hyperplasia. During a follow-up period of 2 months there were no further epi- sodes of hematuria. A repeat cystoscopic examination failed to reveal any lesion on the trigone. Because of the small size and the capillary type of the lesion, the post- biopsy repair process probably had resolved the residual lesion.

DISCUSSION Until recently, single case reports of bladder heman-

gioma have appeared in the literature [Proca, 1977; Fu- leihan and Cordonnier, 19691 indicating the rarity of such lesions. In 1955 Melicow reported 6 cases of bladder hemangiomas while studying 954 cases of primary blad- der tumor. Sarma [1969] reviewed the literature up to 1966 and found 64 recorded cases. Fuleihan and Cordon- nier 119691 reported 1 case of their own and analysed another 20 cases from the literature (1942- 1968).

Clinical Presentation Gross painless hematuria is the most common present-

ing feature. More than 50% of the patients are less than 20 years of age at the time of presentation. Of the re- corded cases, age has varied from a few weeks to more than 70 years. Up to 25% of the cases may have cuta- neous hemangiomas over abdomen, perineum, and thighs.

Pathology A single tumor is present in the majority of cases. The

usual location is posterior and lateral walls, and the dome; involvement of the trigone or the floor is rare. The size of the lesion varies from a few mm to 10 cm in diameter. Most of the lesions are sessile with bluish-red

Accepted for publication February 22, 1983. Address reprint requests to Deba P. Sarma, MD, Department of Pathology, VA Medical Center, 1601 Perdido Street. New Orleans, LA 70146.

0 1983 Alan R. Liss. Inc.

Hemangioma of the Urinary Bladder 143

Fig. I. Hemangiorna ol'thc bladdcr (H&E. x 60).

overlying mucosa. Microscopically, more than 50 % of the lesions are cavernous hemangioma, and the rest are of the capillary type.

Diagnosis and Treatment

Intermittent gross painless hematuria in a young pa- tient, especially with hemangioma of skin, is highly suggestive of hemangioma of urinary tract. Clinical di- agnosis is usually established by cystoscopic examina- tion. Controversy remains as to whether to biopsy a

suspicious lesion. If the lesion is large and highly suspi- cious for hemangioma, a biopsy is not indicated on the premise that intractable bleeding may occur. For small lesions in adults with no clear indication of the diagnosis, biopsy may be indicated.

Partial cystectomy is curative for large lesions. Small lesions may be locally excised or fulgurated, although this remains controversial. Extensive hemangioma may need total cystectomy. Radiotherapy has been used suc- cessfully in a few cases.

144 Sarma and Weiner

In spite of its benign nature and slow growth, bladder REFERENCES hemangiomas need to be recurrent hernaturia.

treated to avoid Fuleihan FM, Cordonnier J J (1969): Hernangiorna of the bladder: Report ofa case and review of thc literature. J Urol 102:581-585.

Melicow MM (1955): Tumors of the urinary bladder: A clinicopatho- logical analysis of over 2500 specimens and biopsies. J Urol

ACKNOWLEDGMENTS 74~498-521. Proca E (1977): Hernangioma of the bladder. Br J Urol49:O. Sarrna KP (1969): Turnours of the urinary bladder. New York: Apple- we thank MS. Karen for

help. ton-Century-Crofts. pp 105- 107.