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Pathology for Urologists

Smooth Muscle Tumors


Image A
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Image B
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Leiomyoma

  • Rare, but considered the most common benign mesenchymal tumor in the bladder.
  • More common in female, may present with obstructive symptoms.
  • Gross: well-circumscribed submucosal mass (< 2 cm) with firm gray-white trabeculated cut surface; rare cases of up to 25 cm in size (image A).
  • Histology:
    • Fascicles of spindle cells with cigar-shaped nuclei (image B).
    • No mitoses or necrosis.
  • Excellent prognosis.

Image C
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Image D
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Leiomyosarcoma (LMS)

  • Rare, but is the most common type of sarcoma that arises in the bladder.
  • More common in male.
  • Gross: lobulated gray-tan mass (mean 7 cm) often with necrosis, with or without ulceration of the overlying mucosa.
  • Histology:
    • Fascicles of spindle cells with cigar-shaped nuclei that is more atypical (image C) & (image D).
    • Abundant mitoses and necrosis.
  • DDX: sarcomatoid carcinoma and myofibroblastic tumor, which both similar to LMS express smooth muscle actin (traditionally a smooth muscle tumor marker) and pankeratin (traditionally an epithelial marker) (beware of these overlap).

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