ABSTRACT
OBJETIVO: Presentar tres casos de enfermedadateroembólica con debut clínico en tracto urinarioinferior. Esta enfermedad es infrecuente, afectandosobre todo piel, riñón y músculo esquelético. Otrosórganos del tracto urinario son raramente afectados yde forma extraordinaria como debut de la enfermedad,sin afectación previa conocida de otras localizaciones.MÉTODOS/RESULTADOS: El primer paciente presentabaun episodio de hematuria asociado con una imagenecográfica y cistoscópica sospechosa de neoplasia.En los fragmentos de resección transuretral la lesióncorrespondía a una cistitis polipoide con algunas arteriasde pequeño tamaño ocupadas por agujas decolesterol, asociado con inflamación, ulceración y extravasación hemática. Al segundo paciente se le realizóuna cistoprostatectomía por un carcinoma urotelial,encontrándose incidentalmente numerosos émbolos decolesterol principalmente en lámina propia, pero tambiénen otras capas de la pared vesical, próstata, uretraen el verumontanum y una vesícula seminal, estasdos últimas localizaciones no descritas en publicacionesanteriores. En el tercer paciente el émbolo seencontró en un cilindro de biopsia prostática.CONCLUSIONES: Esta enfermedad poco frecuentepuede debutar como un proceso vesical o prostático yser diagnosticado por medio de biopsia de estos órganos.Puede simular una neoplasia vesical en ecografíao cistoscopia y debería ser incluida entre las entidadesrelacionadas o causantes de cistitis polipoide, un conocidosimulador de neoplasia
OBJECTIVES: To report three cases of ;;atherosclerotic embolic vascular disease with clinical ;;presentation in the lower urinary tract. This disease is not ;;frequent; it mainly affects the skin, kidneys and skeletal ;;muscle. Other organs of the urinary tract are rarely ;;affected and they are exceptionally the clinical site of ;;debut without previous known involvement of other ;;areas. METHODS/RESULTS: The first patient presented with ;;hematuria associated with an ultrasound/cystoscopical ;;image suspicion for neoplasia. Pathologic report of the ;;transurethral resection chips showed polypoid cystitis ;;with some small size arteries occupied by cholesterol ;;needles, associated with inflammation, ulcers and ;;hematic extravasation. The second patient underwent ;;cystoprostatectomy for a transitional cell carcinoma ;;and, incidentally, numerous cholesterol emboli were ;;found, mainly in the lamina propria, but also in other ;;layers of the bladder wall, prostate, urethra, veru ;;montanum, and one seminal vesicle; this two latter sites ;;have not being reported in previous publications. The ;;third patient showed the embolus within a prostate ;;biopsy core. ;;CONCLUSIONS: This unfrequent disease may present ;;as a bladder or prostatic process and be diagnosed by ;;biopsy of these organs. It may simulate a bladder neoplasia ;;on ultrasound or cystoscopy and should be included ;;among related or etiologic entities of polypoid cystitis, ;;a well-known simulator of neoplasia
Subject(s)
Male , Aged , Humans , Arteriosclerosis/complications , Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/etiology , Urinary Bladder Neoplasms/diagnosis , Embolism, Cholesterol/etiology , Embolism, Cholesterol/diagnosis , Diagnosis, DifferentialABSTRACT
OBJECTIVES: To report three cases of atherosclerotic embolic vascular disease with clinical presentation in the lower urinary tract. This disease is not frequent; it mainly affects the skin, kidneys and skeletal muscle. Other organs of the urinary tract are rarely affected and they are exceptionally the clinical site of debut without previous known involvement of other areas. METHODS/RESULTS: The first patient presented with hematuria associated with an ultrasound/cystoscopical image suspicion for neoplasia. Pathologic report of the transurethral resection chips showed polypoid cystitis with some small size arteries occupied by cholesterol needles, associated with inflammation, ulcers and hematic extravasation. The second patient underwent cystoprostatectomy for a transitional cell carcinoma and, incidentally, numerous cholesterol emboli were found, mainly in the lamina propria, but also in other layers of the bladder wall, prostate, urethra, veru montanum, and one seminal vesicle; this two latter sites have not being reported in previous publications. The third patient showed the embolus within a prostate biopsy core. CONCLUSIONS: This unfrequent disease may present as a bladder or prostatic process and be diagnosed by biopsy of these organs. It may simulate a bladder neoplasia on ultrasound or cystoscopy and should be included among related or etiologic entities of polypoid cystitis, a well-known simulator of neoplasia.
