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Bladder MALT Lymphoma : Clinical Features

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Clinical Features: Like other locations, MALT lymphomas of the bladder predominantly affect older patients with a female predominance. The presenting symptoms are non-specific and include hematuria, dysuria, urgency, urinary frequency, nocturia, and abdominal/back pain. Some patients have underlying chronic infectious cystitis or interstitial cystitis.

Endoscopy may show involvement anywhere along the urinary tract, including urinary bladder, urethra, ureter, and renal pelvis. The lymphoma may present as a solitary mass (70% of cases), plaque-like thickening of the bladder wall (10% of cases; shown in this image), or multiple masses (20% of cases). The tumor nodule is exophytic or sessile with intact smooth overlying urothelium but may show erythematous changes and even ulceration (more common with secondary involvement). Most cases are localized to the bladder at presentation. With urethral involvement in female patients, the mass may protrude at the meatus and mimic caruncle.

Case History: This transurethral resection specimen of bladder with MALT lymphoma is from an elderly female with history of overactive bladder and pelvic prolapse. An abdominal CT scan showed diffuse thickening of the right side wall of the bladder.

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