PMC6559226_01
The large mass in the right lateral wall of the bladder (arrows): sagittal and axial T2W images (A, B, respectively); cystoscopy in white light (C); cystoscopy in the mode of computer chromoendoscopy "Clara-Chroma" (D); hemangioma in the "Spectra B" mode (E); transurethral resection of the exophytic part of the tumor (F); tumor bed in white light (G); tumor bed in the "Spectra B" mode (H).
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Following that, MRI revealed a large mass in the right lateral wall of the bladder, 2.6x2.1 cm in size (Figure 1A, B). The tumor had a wide base and ulcerative defects covered with blood clots (Figure 1C). The dilated vessels of different caliber were observed in submucosal layer (Figure 1D) in computer-enhanced contrast mode in conditions of more uniform illumination (<<Clara-Chroma>> , Karl Storz, Germany). Pathological vascularization common for urothelial carcinomas was not found in the tumor, its base or bladder mucosa (Figure 1E) by computer modulation of a light beam (SPECTRA B , Karl Storz, Germany). A bladder transurethral resection of exophytic part of the tumor was performed (Figure 1F). Hemorrhage zones were located in the tumor bed by white light and by the mode of computer chromoendoscopy (Figure 1G, H).
Hemangioma in bladder wall, cystic dilated von Brunn's nests (*) and hemorrhages (arrow) around hemangioma, hematoxylin and eosin (A, B, magnification 50x). Positive tumor endothelium staining with anti-CD34 (C, magnification 100x) and anti-CD31 (D, E, magnification 200x) antibodies, hemorrhages (arrows). Alfa-SMA positive smooth muscle cells in blood vessels with arteriovenous malformation in hemangioma (F, magnification 200x). Tumor bed (*) contained a few normal vessels with CD34- and CD31-positive endothelium (G, H, respectively, magnification 100x) and consisted of alfa-SMA-positive bladder muscle layer (I, magnification 100x).
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In histological and immunohistochemical studies, the bladder tumor was shown to be a hemangioma of mixed histological structure (Figure 2).