Anaplastic T-cell lymphoma of the urinary bladder with unspecific clinical and radiological characteristics – a unique case report

Purpose: To report a case of extremely rare anaplastic T-cell lymphoma of the urinary bladder in an advanced stage, with completely unspecific radiological features and symptomatology mimicking necrotic myomas. Case Report: A 38-year-old women was admitted for pelvic pain, dysuria, enlarged uterus, subfebrile temperature, but without vaginal bleeding and hematuria. On ultrasound scan necrosis of the uterine myomas was suspected. Magnetic resonance imaging revealed an anteuterine tumor (9×9×11 cm) infiltrating the uterus and urinary bladder and retrouterine formation (7×5×7 cm) adhering to the posterior uterine wall and rectum, right kidney hydronephrosis, and parailiac lymphadenopathy. Cystoscopy confirmed the presence of the tumor on the posterior bladder wall and bladder roof infiltrating the right ureteral orifice. Histopathological and immunohistochemical analyses of tumor biopsy confirmed the presence of T-cell anaplastic ALK+ non Hodgkin’s lymphoma of the urinary bladder. Conclusion: This case report shows that pelvic pain and dysuria alone can imply on urinary bladder tumors even in the absence of hematuria. Additionally, uniqueness of this case lies in the younger age of the female patient. Moreover, the authors showed for the first time that lymphomas could spread locally into both uterus and intestines, without systemic dissemination.