Müllerianosis of the urinary bladder: a rare case report and review of the literature

The aim of this paper is to report a very rare case of müllerianosis (endosalpinx, endometrium, and endocervix) in a post-menopausal woman. Müllerianosis of the bladder is a very rare disease, which affects mainly the women of the reproductive age group, but with a good prognosis if the transitional bladder carcinoma is resolved. We present the case of a 64-year-old woman complaining of left lower abdomen pain, repeated lower and upper tract urinary infections, emergency urinary incontinence and hematuria. The surgical history shows that she underwent a hysterectomy, caesarean section and appendectomy. The clinical examination emphasizes a normal abdomen, with a normal aspect of the post-operative scars and a second-degree cystocele. An abdominal computed tomography (CT) scan with contrast and a cystography were performed and showed a 16 mm lesion-like tumor on the left bladder wall respectively a third-degree vesicoureteral reflux. These investigations were followed by a cystoscopy and transurethral resection of the bladder tumor (TURBT). The histopathology report described three types of tissues: endometriosis, endocervicosis and endosalpingiosis. Sequent to these results, a partial cystectomy with the re-implantation of the left ureter was performed. Once again, the results of the specimen confirm the diagnosis of müllerianosis. The immediate post-operative outcomes were good, the patient having no pains and no more hematuria. Six month later, a tension-free vaginal tape obturator (TVT-O) operation was carried out for urinary incontinence and two years later, a correction for a post-surgical abdominal hernia was performed. Müllerianosis of the bladder is a very rare disease, which affects mainly the women at the procreation age, but with a good prognosis. The differential diagnosis with a malignant tumor is very important to be carefully made. Currently, there is no golden standard to treat this disease. The cystoscopy and the histopathological examination of the specimen are indispensable for the certainty diagnosis.