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LETTER TO EDITOR
Year : 2013  |  Volume : 50  |  Issue : 4  |  Page : 296
 

Primary non-Hodgkin lymphoma of the bladder


1 Department of Urology, KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
2 AV D'Costa Memorial Hospital, Margoa, Goa, India

Date of Web Publication24-Dec-2013

Correspondence Address:
R B Nerli
Department of Urology, KLES Kidney Foundation, KLE University's JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.123593

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How to cite this article:
Nerli R B, Guntaka A K, Das S, Hiremath M B. Primary non-Hodgkin lymphoma of the bladder. Indian J Cancer 2013;50:296

How to cite this URL:
Nerli R B, Guntaka A K, Das S, Hiremath M B. Primary non-Hodgkin lymphoma of the bladder. Indian J Cancer [serial online] 2013 [cited 2020 Oct 25];50:296. Available from: https://www.indianjcancer.com/text.asp?2013/50/4/296/123593


Sir,

A 69-year s -old male patient presented with hematuria and dysuria of few days duration. Ultrasound imaging [Figure 1] revealed multiple tumor like lesions on both the lateral bladder walls. This patient had undergone transurethral resection of similar lesions five years earlier, and histopathological examination was reported as chronic eosinophilic cystitis. The patient was free of symptoms during these past five years. Abdominal computerized tomography confirmed the ultrasonography findings. Urine cytology was negative for malignant cells. Cystoscopy showed multiple bulging lesions on both the lateral walls of the bladder. The mucosal surface of these lesions appeared normal. The ureteral meatus on both the sides appeared normal. Transurethral resection of these lesions was done and the resected chips sent for histopathological examination. Histopathological examination revealed diffuse lymphoproliferative lesions of small round cells with follicular pattern, characterizing a non-Hodgkin lymphoma of the bladder [Figure 2]. Immuno-histochemistry profile revealed an intact urothelium with underlying nodular aggregates of lymphoid cells [Figure 3]. The small lymphoid cells (LCA and CD 20 positive/pancytokeratin) showed fair amounts of cytoplasm with irregular clefted nuclei having coarse chromatin and inconspicuous nucleoli [Figure 4] and [Figure 5]. Mitoses were extremely sparse (<1 MF/10HPE) with occasional plasmacytoid forms, neutrophils and histiocytes noted. Further clinical, radiological and laboratory investigations revealed no evidence of lymphoma elsewhere. The patient was put on chemotherapy (R- CHOP regimen). The patient has been on follow up of over six months. The last ultrasound done six months after diagnosis, revealed no evidence of lesions.
Figure 1: Ultrasound image showing multiple tumor like lesions on both the lateral bladder walls

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Figure 2: HPR slide showing diffuse lymphoproliferative lesions of small round cells characterizing a non-Hodgkin lymphoma of the bladder (H and E stain)

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Figure 3: Immuno-histochemistry of the lesion revealing an intact urothelium with underlying nodular aggregates of lymphoid cells

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Figure 4: Photomicrograph showing small lymphoid cells stained by LCA staining

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Figure 5: Photomicrograph showing CD 20 positive/pancytokeratin lymphoid cells with fair amounts of cytoplasm with irregular clefted nuclei having coarse chromatin and inconspious nucleoli

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Most tumors of the bladder arise from the epithelium. Non-epithelial tumors are extremely rare. Among these, leiomyosarcomas are the most common in adults and rhabdomyosarcomas are the most common in children. [1] Metastatic tumors more frequently affect the bladder neck and the trigone area and represent approximately 15% of all known bladder malignancies. [2] Primary lymphomas of the bladder are very rare and were first described by Eve in 1885. [3] They represent 0.2% of all known bladder cancers. [3] Secondary bladder involvement is reported in 10 to 50% of cases, with a maximum incidence between the fourth and sixth decades of life. [4],[5] Most lymphomas of the bladder are low-grade non-Hodgkin's lymphomas (NHL) of the B-cell type. [1],[5] Women are affected more frequently than men. [3],[5] Haematuria is the most frequent of symptoms, followed by concomitant urinary tract infection, dysuria and increased urinary frequency. [5] Other presentations like hydronephrosis, fistulas or involvement of the entire bladder are very rare. [5] Mucosa associated lymphoid tissue (MALT)- type lymphomas are the most common form of primary involvement of the bladder. The prognosis of these cases is usually good, and most series do not report deaths associated with the disease. These lesions can be single or multiple, and irritative bladder symptoms occur because of them. Nearly 20% of these cases may present with a history of chronic cystitis. [5] Patients with non-localized bladder lymphoma tend to present with fewer lower urinary tract symptoms. The occurrence of secondary involvement of the bladder by a systemic lymphoma is more common than primary involvement. Necropsy studies show that 10-20% of cases of systemic non-Hodgkin lymphoma can involve the bladder secondarily. [2] Usually such patients are treated with salvage chemotherapy, and mean survival can range from five to eight years. [5] The role of Rituximab in the treatment of non-Hodgkin lymphoma has evolved significantly since its introduction. Several randomized clinical trials (RCTs) of rituximab based therapy have revealed consistent and clinically important benefits in progression-free and overall survival. [6]

 
  References Top

1.Mourad WA, Khalil S, Radwi A, Peracha A, Ezzat A. Primary T-cell lymphoma of the urinary bladder. Am J Surg Pathol 1998;22:373-7.  Back to cited text no. 1
[PUBMED]    
2.Bates AW, Baithun SI. Secondary neoplasms of the bladder are histological mimics of non-transitional cell primary tumors: Clinicopathological and histological features of 282 cases. Histopathology 2000;36:32-40.  Back to cited text no. 2
[PUBMED]    
3.Kuhara H, Tamura Z, Suchi T, Hattori R, Kinukawa T. Primary malignant lymphoma of the urinary bladder: A case report. Acta Pathol Jpn 1990;40:764-9.  Back to cited text no. 3
[PUBMED]    
4.Arda K, Ozdemir G, GunesZ, Ozdemir H. Primary malignant lymphoma of the bladder: A case report and review of literature. Int Urol Nephrol 1997;29:319-22.  Back to cited text no. 4
    
5.Kempton CL, Kurtin PJ, Inwards DJ, Wollan P, Bostwick DG. Malignant lymphoma of the bladder: Evidence from 36 cases that low grade lymphoma of the MALT-type is the most common primary bladder lymphoma. Am J Surg Pathol 1997;21:1324-33.  Back to cited text no. 5
[PUBMED]    
6.Cheung MC, Haynes AE, Meyer RM, Stevens A, Kevin R. Imrie Rituximab in lymphoma: A systematic review and consensus practice guideline from Cancer Care Ontario. Cancer Treat Rev 2007;33:161-76.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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