Urinary bladder xanthoma: a report of 2 rare cases highlighted with anti-CD68 antibody

Bladder xanthoma: clinical analysis of 22 cases from multiple centers

This study aims to outline the clinical and pathological characteristics of bladder xanthoma, alongside its diagnostic and treatment approaches.

METHODS

We reviewed bladder xanthoma literature spanning the last 60 years from databases such as PubMed, Web of Science, Embase, and Medline. Additionally, we analyzed clinical data from a singular case of bladder xanthoma treated at our hospital. Patient particulars, including age, gender, symptoms, tumor size, associated neoplasms, imaging results, and pathological findings, were documented. Tumors underwent surgical removal, followed by pathological examination of the excised tissues. Subsequent to surgery, patients underwent cystoscopy follow-up after 3 months.

RESULTS

Among the 22 identified cases of bladder xanthoma, 15 were solitary (comprising both single and multiple lesions), while 7 were associated with urinary tract epithelial tumors. There were 6 male patients and 1 female patient concurrently diagnosed with urinary tract epithelial carcinoma. Males exhibited an average onset age of 56.0 years, with an average tumor diameter of 21.57 mm. Females presented an average onset age of 63.00 years, with an average tumor diameter of 20.86 mm. The onset age for females was notably lower than that for males, and their tumor diameter was significantly smaller than that of males (P<0.05). Among the 9 patients with lipid metabolism disorders, 7 were males and 2 were females, indicating a marked male predominance. No instances of recurrence or malignant transformation were observed during follow-up. In this study, we treated a 65-year-old female patient who, during cystoscopy, exhibited a round, hanging lesion measuring about 2.5 × 1 × 1 cm on the left side of the ureteral opening in the bladder trigone. Post-surgery, pathological examination disclosed bladder xanthoma with multiple groups of foam cells. Immunohistochemistry findings were as follows: CD68 (+), CD163 (+), Vimentin (+), CK (-), Desmin (-). A follow-up cystoscopy after 3 months did not reveal any tumor recurrence.

CONCLUSION

Bladder xanthoma is an uncommon benign condition predominantly affecting older males. It frequently manifests on the side walls and trigone region of the bladder and may be linked to lipid metabolism disorders. Approximately 50% of patients exhibit concurrent urinary tract epithelial tumors, with diagnosis primarily reliant on microscopic tissue examination. Prolonged post-surgical follow-up is imperative.

Urinary Bladder Xanthoma - Is Immunohistochemistry Necessary?

Urinary Bladder Xanthomas (UBX) are non-neoplastic reactive tumor like process. Isolated UBX is rare with only around 15 cases reported (Yu, Patel, & Bonert, 2015). UBX are reported in older patients who present with non specific symptoms like UTI or hematuria. Patients often have associated lipid anomalies. UBX have been vaguely described as yellowish white plaques or patches. Also, recent reports have stressed on the role of Immunohistochemistry in the diagnosis (Al-Daraji, Varghese, & Husain, 2007; Vimal, Masih, Manipadam, & Chacko, 2012). The objective of this report is to provide a cystoscopic view of the tumor which will enable easier identification and also to debate on the role of IHC in diagnosis.

Xanthoma of the urinary bladder: a rare benign condition which may be mistaken for malignancy

A 77-year-old man was referred with a history of recurrent urinary tract infections and a raised prostate-specific antigen. He was found to have an atypical lesion of the urinary bladder on cystoscopic examination. A preoperative MRI study suggested no evidence of malignancy and histology was consistent with urinary bladder xanthoma. This is a benign and exceedingly rare condition which requires no further treatment or follow-up. Patients should, however, have a lipid profile measured. Our case illustrates the use of MRI as an adjunct to aid operative planning. Although not essential, it may help to avoid an over aggressive initial resection in more precarious areas of the urinary bladder.

Xanthoma of the urinary bladder - A rare entity

Xanthomas of the urinary bladder are rare. They may be associated with metabolic disorders. We hereby report a case of bladder xanthoma.