Bladder Xanthoma: Clinical Analysis of 22 Cases from Multiple Centers

AbstractObjective This study aims to describe the clinical and pathological features of bladder xanthoma, along with its diagnostic and treatment methods. Methods We gathered literature about bladder xanthoma published over the past 60 years from databases like PubMed, Web of Science, Embase, and Medline. We also collected clinical data from a single case of bladder xanthoma treated at our hospital. Patient details such as age, gender, symptoms, tumor size, related neoplasms, imaging results, and pathological findings were noted. Tumors were removed through surgery, followed by examining the removed tissues pathologically. After surgery, patients underwent cystoscopy follow-up after 3 months. Results Out of the 22 identified cases of bladder xanthoma, 15 were isolated (including both single and multiple lesions), while 7 were connected with urinary tract epithelial tumors. There were 6 male patients and 1 female patient with concurrent urinary tract epithelial carcinoma. Males had an average onset age of 56.0 years, with an average tumor diameter of 21.57 mm. Females had an average onset age of 63.00 years, with an average tumor diameter of 20.86 mm. The onset age for females was notably lower than that for males, and their tumor diameter was significantly smaller than that of males (P < 0.05). Among the 9 patients with lipid metabolism disorders, 7 were males and 2 were females, showing a significant male predominance. No instances of recurrence or malignant transformation were noted during follow-up. In this study, we treated a 65-year-old female patient who, during cystoscopy, showed a round, hanging lesion measuring about 2.5 x 1 x 1 cm on the left side of the ureteral opening in the bladder trigone. After surgery, pathological examination revealed bladder xanthoma with multiple groups of foam cells. Immunohistochemistry findings were as follows: CD68 (+), CD163 (+), Vimentin (+), CK (-), Desmin (-). A follow-up cystoscopy after 3 months did not uncover any tumor recurrence. Conclusion Bladder xanthoma is a rare non-cancerous condition that mainly affects older males. It often appears on the side walls and trigone region of the bladder and could be associated with lipid metabolism disorders. Around 50% of patients have simultaneous urinary tract epithelial tumors, and diagnosis mainly depends on examining tissues under a microscope. Prolonged follow-up after surgery is not necessary.