Mullerianosis of the Urinary Bladder: A Case Report

A 65-year-old woman was found to have an incidental 2 cm bladder mass found on CT. She reported a 22 year smoking history but did not have any urologic symptoms and urinalysis was unremarkable. A cystic and solid tumor located approximately 2-3 cm cephalad of the left UO along trigonal ridge was found on cystoscopy and a transurethral resection of the suspected tumor was performed. The histopathological examination supported the diagnosis of bladder involvement by a mullerian lesion. 

Outcomes:

Mullerianosis of the bladder although a rare disease needs to be correctly identified to provide appropriate treatment and avoid misdiagnosis. The clinical presentation, although varied, most often presents in women of childbearing age with hematuria, dysuria, abdominal pain and or pelvic pain but our case presented as one of the few asymptomatic cases. Two main theories regarding the pathogenesis of mullerianosis have been described, the implantation theory described by Young and Clement and the metaplastic theory proposed by Donne et al. There have been other hypotheses mentioned such as a metaplastic origin suggested by Koren et al and  Branca and Barresi proposed that the secondary mullerian system is able to retain its ability to differentiate into different types of mullerian tissue.  

Conclusion:

Mullerianosis of the urinary bladder is a rare entity that is most commonly mistaken for a neoplastic lesion. It mainly affects the bladder of females during their reproductive years with prior pelvic surgery.