Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2012  |  Volume : 8  |  Issue : 2  |  Page : 297-299

Primary amyloidosis with high grade transitional cell carcinoma of bladder: A rare case report

Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, India

Date of Web Publication26-Jul-2012

Correspondence Address:
Prashant Gupta
Room No. 717, 7th Floor, MRC Building, Bombay Hospital, 12 New Marine lines, Mumbai 400020
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.98994

Rights and Permissions
 > Abstract 

Primary amyloidosis of bladder is a rare disease that closely resembles bladder cancer on clinical presentation with painless gross hematuria. Pathologically this is a totally benign non-neoplastic lesion and its association with urothelial carcinoma of the bladder is rare. We herein report a 64-year-old diabetic male who has been treated for primary amyloidosis of bladder for the last 26 years presented recently with high-grade solid urothelial cancer with osseous metaplasia and sarcomatoid change of bladder with area of amyloid deposition.

Keywords: Amyloidosis, painless hematuria, urothelial cancer

How to cite this article:
Gupta P, Hanamshetti S, Kulkarni JN. Primary amyloidosis with high grade transitional cell carcinoma of bladder: A rare case report. J Can Res Ther 2012;8:297-9

How to cite this URL:
Gupta P, Hanamshetti S, Kulkarni JN. Primary amyloidosis with high grade transitional cell carcinoma of bladder: A rare case report. J Can Res Ther [serial online] 2012 [cited 2022 Aug 11];8:297-9. Available from: https://www.cancerjournal.net/text.asp?2012/8/2/297/98994

 > Introduction Top

Amyloidosis is a heterogenous group of disorder which is benign, non-neoplastic characterized by extracellular deposition of fibrillar protein in tissue. [1] Clinically it can present as a primary or secondary disorder with systemic or localized manifestation. Primary localized amyloidosis of the urinary bladder presents with lower urinary tract symptoms (LUTS) and painless gross hematuria and mimics carcinoma of the bladder on imaging and cystoscopy. Generally the diagnosis is made on histological examination after specific staining with Congo red. Further it may coexist with malignancy.

 > Case Report Top

Recently in April 2011, we saw a 64-year-old male patient with painless intermittent gross hematuria. For the last 26 years, he was treated at our institution for chronic primary amyloidosis of bladder with repeated trans urethral resections (TURBT) (six times, last in 2004) and each time the biopsy proved amyloidosis.

During the latest episode, complete evaluation showed normal hematocrit and biochemistry. Sonography showed multiple solid lesions on right lateral and posterior wall of bladder with right mild hydro-uretero nephrosis. On cystoscopy, there were multiple yellowish fat like deposits in the membranous urethra and right lateral wall of the bladder. Additionally multiple solid nodular lesions were seen in the bladder. Histology of the TURBT with deep muscle biopsy reported high-grade solid TCC [Figure 1]a with WHO grade III [Figure 1]b muscle invasion present, and [Figure 1]c focal osseous metaplasia with amyloidosis. CT scan showed multiple nodules with thick bladder with multiple focal calcification area and right side mild hydroureteronephrosis [Figure 1]d. In view of the above findings, he underwent radical cystectomy with ileal conduit. Cystectomy specimen showed multiple nodular areas of tumor with ulceration with whole thickened bladder [Figure 2]a. Microscopy confirmed sarcomatoid differentiation TCC [Figure 2]b with amyloidosis by the presence of apple green birefringence [Figure 2]c in the section stained with alkaline Congo red under a polarized light [Figure 2]d. Bilateral ureteric margins were positive for amyloid but negative for malignancy TCC. Final pathological staging was pT3b N1M0. At latest follow up, he is alive and well. He has been referred for adjuvant chemotherapy.
Figure 1:

Click here to view
Figure 2:

Click here to view

 > Discussion Top

Historically amyloid term was coined by Virchow in 1854. Solonis first described bladder amyloidosis in 1897 at autopsy. Further amyloidosis of bladder with high-grade TCC is very rare [2] and review of literature shows only two previous reports till date. Amyloidosis of the bladder primarily affects posterior and posterior lateral walls with unknown etiology. It is mainly AL type Ig light chain. It is mainly present with gross painless hematuria and has clinical resemblance with bladder cancer. [3] Urinary dysfunction is found in 50% cases in patients due to amyloidotic neuropathy. It has very high rate of local recurrence. Cystoscopic appearance varies from solid circumscribed elevated sessile lesion to a grossly congested and ulcerated mucosa with petechial haemorrhage involving the whole bladder. Management of primary amyloidosis is mainly TURBT with symptomatic therapy if it is localized. [4] Adjuvant intravesical dimethyl sulfoxide therapy has been useful in selected patients with intractable hematuria. [5] However, follow up periodic cystoscopy is mandatory. Cystectomy is the option in some patients when the symptoms are life threatening.

Our case is unique because it exhibits long benign nature of amyloidosis which could be managed by repeated transurethral resections and hence cystectomy could be avoided for over two and a half decades. At each time, we tried to rule out coexisting urothelial malignancy to avoid pathological miss. However after long time (26 years), he did develop urothelial malignancy indicating the need for life long vigilant follow up, including meticulous biopsy of the lesions. It is safe to summarize that amyloidosis does not exhibit causal relationship with bladder cancer which may develop as an independent disease during the follow up. Further treatment of such a bladder cancer is not different from the other bladder cancers.

 > Acknowledgment Top

We are highly thankful to Dr. D. D. Gaur for allowing us to operate on his patient and also to Dr. Mazumdar and Dr K. Patel of pathology department of our hospital for providing histopathology slides.

 > References Top

1.Jain M, Kumari N, Chhabra P, Gupta RK. Localized amyloidosis of urinary bladder: A diagnostic dilemma. Indian J Pathol Microbiol 2008;51:247-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Biyani CS, Fitzmaurice RJ, Upsdell SM. Localized amyloidosis of the urethra with transitional cell carcinoma of the bladder. BJU Int 1999;83:722-3.   Back to cited text no. 2
3.Auge BK, Haluszka MM. Primary amyloidosis of the bladder. J Urol 2000;163:1867-8.  Back to cited text no. 3
4.Zaman W, Singh V, Kumar B, Mandhani A, Srivastava A, Kumar A, et al. Localized primary amyloidosis of the genitourinary tract: Does conservation help? Urol Int 2004;73:280-2.  Back to cited text no. 4
5.Malek RS, Wahner-Roedler DL, Gertz MA, Kyle RA. Primary localized amyloidosis of the bladder: Experience with dimethyl sulfoxide therapy. J Urol 2002;168:1018-20.  Back to cited text no. 5


  [Figure 1], [Figure 2]

This article has been cited by
1 Case report. Primaire amyloïdose van de blaas
M. Lammers,R.J.A.M. Davits
Tijdschrift voor Urologie. 2014; 4(2): 62
[Pubmed] | [DOI]
2 Amyloidosis in the bladder: Three cases with different appearance
Katrine Skydsgaard Schou-Jensen,Claus Dahl,Anette Pedersen Pilt,Nessn Htum Azawi
Scandinavian Journal of Urology. 2014; : 1
[Pubmed] | [DOI]
3 Urinary cytopathology in primary bladder amyloidosis
Toll, A.D. and Ali, S.Z.
Acta Cytologica. 2013; 57(3): 271-275


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Case Report>Discussion>Acknowledgment>Article Figures
  In this article

 Article Access Statistics
    PDF Downloaded222    
    Comments [Add]    
    Cited by others 3    

Recommend this journal