XANTHOMA OF THE BLADDER ASSOCIATED WITH TRANSITIONAL CELL CARCINOMA

We report a case of xanthoma and transitional cell carcinoma of the bladder discovered incidentally during routine cystoscopy for hematuria. Xanthoma is rare in the bladder with only 8 cases reported previously. Of these cases 6 were reported in the Japanese literature. Interestingly, the coexistence of xanthoma and carcinoma has been reported only once in association with a diverticulum of the bladder. Since many bladder xanthomas may either be discovered incidentally or complicate a bladder tumor, followup cystoscopy should always be considered. CASE REPORT A 65-year-old man presented with a recent history of hematuria, dysuria and lower abdominal pain. Physical examination did not reveal any disease or dermatological signs. Hematological and biochemical evaluations were normal, and urine culture was negative. Digital rectal examination revealed homogeneous benign prostatic hyperplasia. Prostate specific antigen was normal. There was no history of skin xanthomas, diabetes mellitus, liver disease, hyperlipidemia or hypothyroidism. Furthermore, the patient did not mention any bladder surgery, trauma or inflammation. At cystoscopy a 1.8 3 2 cm. nodular, velvety yellowish lesion was found to the left of the trigone. Transurethral resection was performed and histopathological findings were xanthoma adjacent to superficially invasive grade II transitional cell carcinoma (fig. 1). The lamina propria had been entirely replaced by closely packed polygonal cells with distinct cell membrane. The nuclei were relatively uniform, small and round to oval, with inconspicuous nucleoli. The cytoplasm was clear to finely granular (fig. 2). No mitotic figures were found. There were no associated inflammatory, giant cells, Michaelis-Gutman inclusion bodies or granuloma formation. DISCUSSION