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Case Report
 
Bladder Melanosis: A rare case report
Ricardo Godinho1, Edgar Tavares2, Rui Oliveira3, Paulo Conceição4
1Resident Of Urology at Instituito Português de Oncologia de Coimbra Francisco Gentil (IPOCFG), Portugal.
2MD, Department of Urology, Centro Hospitalar e Universitário de Coimbra, Portugal.
3Resident of Pathology at Centro Hospitalar e Universitário de Coimbra, CHUC, Coimbra, Portugal; PhD Student at Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Co-chair of the ESP Residents Committee; Assistant Professor of Histology & Embryology at Universidade Católica Portuguesa - Centro Regional de Viseu, Viseu, Portugal.
4MD, Instituito Português de Oncologia de Coimbra Francisco Gentil (IPOCFG), Portugal.

Article ID: 100003Z15RG2016
doi:10.5348/Z15-2016-3-CR-3

Address correspondence to:
Ricardo Godinho
Instituito Português de Oncologia de Coimbra Francisco Gentil Av. Bissaya Barreto 98
3000-075 Coimbra
Portugal

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How to cite this article:
Godinho R, Tavares E, Oliveira R, Conceição P. Bladder Melanosis: A rare case report. J Case Rep Images Urol 2016;1:8–11.


Abstract
Introduction: Bladder melanosis is an extremely rare condition first reported in 1986 and refers to abnormal deposits of melanin in the urothelial bladder cells. Typically, it is considered a benign condition, but it has also been described associated with urothelial carcinoma and melanoma. Its diagnosis may be difficult for most urologists because of its rarity.
Case Report: We present the case of a 64-year-old male, former smoker and with a history of previous transurethral resection of prostate with macroscopic hematuria and lower urinary tract symptoms over the last six months. Bladder cytology showed reactive transitional cells, with lots of histiocytes, containing a brown-blackish pigment, positive for Masson-Fontana technique. The patient was submitted to a transurethral resection (TUR) of bladder of all macroscopic lesions under general anesthesia because of the clinic suspicion. Bladder biopsy histologically revealed diffuse dark brown-black pigment mostly within the superficial lamina propria. In conclusion, the histopathological result was compatible with primary bladder melanosis. Our patient had a two-year follow-up with annual cystoscopy and cytology, with no signs of recurrence of lesions with normal macroscopic urothelium findings.
Conclusion: Bladder melanosis of the urinary bladder is a rare condition. Initial evaluation should include cystoscopy and, eventually, upper urinary imaging. The possibility that bladder melanosis can be associated with premalignant and malignant urothelial lesions, suggests a close follow-up with, at least, annual cystoscopy and cytology. In our case, cytology had a pivotal role in the early diagnosis and characterization of the disease.

Keywords: Benign, Bladder, Hematuria, Melanin, Melanosis


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Author Contributions
Ricardo Godinho – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Edgar Tavares – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rui Oliveira – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paulo Conceição – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Ricardo Godinho et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.