ABSTRACT
Objective To investigate the etiology,clinical manifestations,imaging finding,pathology and treatment of primary bladder schwannoma.Methods A case of bladder schwannoma was reported and discussed in the literature.A 64-year-old male patient with painless gross hematuria for 4 months was admitted on October 5,2016.Enhanced computed tomography (CT) showed left anterior bladder wall lesions with mildly enhancement.Preoperative diagnosis was bladder cancer.The patient underwent transurethral resection of bladder tumor (TURBT).During surgery,a 3 cm × 3 cm polypoid soft tissue was found in the left side of bladder,which convex to the bladder with smooth surface and wide base.Results The bladder neoplasm was resected successfully.The intraoperative bleeding was about 100 ml.Postoperative pathology showed a large number of myloid spindle cells with immunohistochemical S-100 (+),considering source of mesenchymal tissue.No recurrence was noticed during the 3 months' follow-up.Retrieving domestic and foreign literature,we found 17 cases with bladder schwannoma from 1993 to 2016.Bladder schwannoma occurs in the age of 40-69 years old.There is no relationship with the agenda.It is often seen in the top or the side wall of the bladder with single growth and rare malignant.The clinical manifestations was mainly painless gross hematuria,CT and magnetic resonance imaging(MR) showed less specificity than other solid tumors of the bladder,which is difficult to identify.Partial cystectomy or TURBT is the main strategy.Postoperative pathology is the gold standard for diagnosis.The immunohistochemical stainings often showed S-100(+).Conclusions Bladder schwannoma is extremely rare in benign bladder tumor,and it could easily be misdiagnosed.The diagnosis should be performed by histopathological examination.Because it will become malignant,it is suggested that the positive treatment should be done.Treatment methods have not been clearly defined,and the effect of surgical resection is good.
ABSTRACT
Objective To evaluate the clinical efficacy of super-selective prostatic arterial embolization(PAE) for the treatment of benign prostatic hyperplasia(BPH).Methods From February 2012to March 2015,a total of 17 patients with BPH who failed in medical treatment,or unwilling to accept surgery were selected for PAE as the study group.The mean age was 73 years (range 61-84 years) and the mean prostatic volume was 64.6 ml (ranging 50-85 ml).The study group underwent super selective arterial embolization.The internal iliac artery angiography was performed and the main blood vessel of prostate was showed.The femoral artery was punctured under local anesthesia and X-ray monitoring,a F4-5 Cobra catheter was inserted,and then the Embosphere microspheres were implanted.A total of 40 patients who underwent transurethral resection of the prostate(TURP) were selected as the control group.The mean age was 70 years (ranging 59-87 years).The mean prostatic volume was 68.7 ml(ranging 55-90 ml).All cases were followed up for 1 year.The changes of prostatic volume (PV),international prostate symptom score(IPSS),quality of life (QOL),pre-and post-treatment peak urinary flow (Qmax) were evaluated.Results For the 17 patients who underwent PAE,the PV decreased from (64.6 ± 10.2) ml to(42.0 ± 7.5) ml,the IPSS decreased from 23.9 ±4.9 to 13.1 ±3.5,QOL decreased from 4.1 ±0.7 to 2.1 ±0.7,and Q increased from (9.5 ± 3.7) ml/s to(21.8 ± 4.2) ml/s,which were statistically significant (P ＜ 0.05) compared with the pre-treatment parameters.The post-operative parameters of the control group were also significantly improved compared with the preoperative parameters (P ＜ 0.05).Conclusions PAE is safe and effective in treating BPH,especially for those failing in medical treatment,or unwilling to accept surgery.