Abstract pain, no hematuria, no dysuria, no urgency and

Abstract

Chondroma is a benign tumour of mesenchymal origin and slow growth
that is composed of cartilage, Extra-skeletal presentation of chondromas is
extremely rare and mostly occurs in the soft tissues of the extremities, mainly
in the hands and feet (1, 2 and 3). 
Bladder chonrdoma is very rare condition and only five cases had been
report up to date.

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Introduction

 Chondroma
is a benign tumour of mesenchymal origin and slow growth that is composed of
cartilage, Extra-skeletal presentation of chondromas is extremely rare and
mostly occurs in the soft tissues of the extremities, mainly in the hands and feet
(1, 2 and 3).  Bladder chonrdoma is very
rare condition and only five cases had been report up to date.

Soft tissue chondromas usually affect both sexes equally, between
40 and 70 years of age (5). The origin of this type of tumour is not clear;
however, Huggins (1931) described the ability of the urothelium to induce bone
and cartilaginous metaplasia (6).

A 50-year- old female patient presented with nonspecific
suprapubic pain and bilateral loin pain, on Cystoscopy found  small projection from anterior wall of the
bladder with intact urothelium, looks like from outside. Managed by
transurethral resection. It is necessary to accumulate more cases to obtain
adequate conclusions and to better understand the causes of this pathology.

 

Case report

A 50-year- old female patient presented with nonspecific
suprapubic pain and bilateral loin pain, no hematuria, no dysuria, no urgency
and frequency. She is a known case of DM. and appendectomy done before.

She is not smoker and house wife. 
On ultrasound examination she had  Rt. Lateral growth about 12*10 mm.

Cystoscopy had done for her, found grade 2 bladder trabeculation
and small projection from anterior wall of the bladder with intact urothelium,
looks like from outside.

 Transurethral resection done
for her, there was whitish friable tissue with avascular core

Gross examination of tissue:  two sections,
first one Single gray white fragment of tissue 5 mm in diameter, and second
one two tiny gray white fragments of tissue 8 mm in aggregate. all taken

Microscopically first one section of this part of biopsy shows
thick bundles of detrusor muscle of urinary bladder bordered by submucosal soft
tissue on one side and by edge of chondroid lesion on the other side, and the
second one the section show the outlines of lobulated nodule that has Centre of
hyalined cartilage with scattered chondrocyte and an outer rim of partially
ossified lamellar bone with few osteocytes. There is no evidence of granuloma
dysplasia or invasive malignancy.

 

Discussion

Soft tissue chondroma is benign nodules of hyaline cartilage that
is not attached to bone and tend to occur in hand and feet. Rare occurrence has
been reported in various pelvic organs, including the prostate, bladder, scrotum,
and testis. (4)

Soft tissue chondromas usually affect both sexes equally, between
40 and 70 years of age (5). The origin of this type of tumour is not clear;
however, Huggins (1931) described the ability of the urothelium to induce bone
and cartilaginous metaplasia (6).

The most common mesenchymal 
tumours of the bladder are leiomyomas, leiomyosarcomas, and pleomorphic
undifferentiated sarcomas (formerly malignant fibrous histiocytoma).(7)

There are a number of similarities between this and previous
cases, all six cases were in women between the ages of 50-75 year, and all
arise from anterior wall of the bladder. The similarities in the ages of the
women and the consistent anterior location of their tumors were interesting;
however, no conclusions can be drawn from such a small sample size.

Some studies seem to correlate the pathogenesis of this tumour
with the possible genetic influence demonstrated in monosomies, trisomies,
translocations, and rearrangement of trisomy 11 in cytogenetic studies of soft
tissue chondromas (8) however; clonal mutation has not yet been demonstrated
(9).

Because of its rarity, there is no standard management. All
reported cases were managed primarily with transurethral resection and
cystoscopic surveillance. Complete resection is considered curative (10),
although because of reported local recurrence rates of 15-20% (10) and lack of
spontaneous regression (11), ongoing surveillance is recommended

 

 

Conclusion

Soft tissue chondroma of the bladder is a benign subepithelial
tumour that has rarely been reported, possibly due to under recognition and
under diagnosis.  It is necessary to
accumulate more cases to obtain adequate conclusions and to better understand
the causes of this patholog