Urinary tract leiomyomas: Infrequent neoplasms with a relevant differential diagnosis

Abstract

Clinical case: Leiomyomas are benign mesenchymal tumors that rarely affect the urinary tract. The widespread use of imaging studies has increased its detection in asymptomatic patients.

Materials and methods: Descriptive analysis of patients with a histopathological diagnosis of urinary tract leiomyoma at the Hospital General de Albacete between 2012 and 2020.

Results: We identified 7 cases (2 renal leiomyomas, 4 bladder leiomyomas and 1 case with bladder and renal leiomyoma). In the renal leiomyoma, the mean age was 79 years and, in the bladder, 39 years. Most of the renal leiomyomas were presented as an incidental finding in the intraoperative kidney transplant study and bladder leiomyomas as a radiological finding. There was a predominance of the female sex in both types of leiomyomas. The mean renal tumor size was 0.73 cm and 4.75 cm in the bladder. Definite diagnosis was made by renal biopsy and bladder biopsy-transurethral resection. Histologically, they were made up of smooth muscle cells arranged in intertwined fascicles without mitosis, nuclear atypia or tumor necrosis. Nephrectomy and partial cystectomy were the main surgical treatment.

During follow-up, no recurrence or complication was detected in any patient.

Conclusions: Imaging studies guide us to the diagnosis, but the definitive diagnosis requires a histopathological and immunohistochemical study. The type of surgery depends on the size and location of the leiomyoma. His prognosis is good.