PMC6146617_01
(a) Preoperative and (b, c) intraoperative cystoscopic findings of abnormal bladder lesions. (d) Deposits of amyloid material showing birefringence under polarized light (Congo red stain) (x200).
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After cystoscopic examination with urine cytology and computed tomography (CT) imaging for the evaluation of urologic malignancy, a 2-cm protruding solid bladder mass involving the left ureteral orifice and trigone of the bladder with left mild hydroureteronephrosis were detected, suggesting bladder cancer (Figures 1(a) and 2). Transurethral resection of the bladder mass was performed to confirm pathologic amyloidosis involvement of the left ureteral orifice of the bladder after transfusion of five packs of platelet-concentrated plasma and three packs of fresh-frozen plasma (Figures 1(b) and 1(c)). Further immunohistochemistry results were positive for kappa but not for lambda (Figure 1(d)).
Postoperative follow-up imaging of cystographic computed tomography showing no leakage at anastomosis of ureteroneocystostomy with ureteral stent in situ.
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A clear resection margin was finally confirmed by pathology. 7 days postoperative, CT cystography confirmed the healed anastomotic site between bladder and ureter (Figure 3) and the patient was discharged.