PMC4868903_01
Ultrasound appearance of the mass: the solitary myofibroma arises from the bladder neck gaining the bladder lumen; (a-c): longitudinal and transverse US sections.
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An ultrasound (US) investigation of abdomen was performed and a bladder solitary mass was detected (Figure 1).
Renal ultrasound: absence of hydronephrosis was showed during a complete abdomen US examination; (a) right kidney and (b) left kidney.
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US; it appeared as an exophytic mass protruding into the visceral lumen, originating from the bladder trigone, overhanging the bladder neck. US investigation excluded hydronephrosis (Figure 2) or other lesions in the abdomen, neck, and head.
Intraoperative images. (a) Intraoperative appearance of the vesical trigone, ureteral orifices, and the mass occupying the bladder neck; (b) the mass is removed and the bladder mucosa sutured. An indwelling catheter is inserted as urethral tutor.
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The mass was completely excised (Figure 3).
Pathology. (a-d) (Haematoxylin/eosin): nodular proliferation with superficial normal urothelium; (e) peripheral zones have myoid short fascicles/whorls/nodules of plump myofibroblasts with pale pink cytoplasm and long, tapering nuclei with vesicular chromatin and 1-2 small nucleoli, but no atypia or pleomorphism, often associated with hyalinization, and whorls/nodules can have a vaguely chondroid or chondromyxoid appearance; (f) central zones between the peripheral myoid nodules display cellular areas of round, polygonal, or spindle cells with scant cytoplasm, hyperchromatic nuclei, arranged around thin walled branching ectatic "hemangiopericytic" vessels; often calcification, necrosis, and hyalinization; often apparent subendothelial intravascular growth but still benign with minimal mitotic activity.
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The nodular well-circumcised mass measured 2 cm in diameter and was covered by normal urothelial tissue (Figure 4).