Primary localized amyloidosis of the urinary bladder: A case series of 31 patients

Objective: To evaluate the presentation and prognosis of primary localized amyloidosis of the urinary bladder. Patients and Methods: The medical records of 31 patients with primary local ized amyloidosis of the urinary bladder were reviewed. Immunohistochemical amyloid typing was performed on bladder biopsy specimens from 27 patients. Results: The median age of the 22 men and 9 women was 55 years. Twenty-four patients (77%) presented with gross hematuria (associated with irritative urinary tract symptoms in 6 patients), and 7 (23%) had only irritative lowe r urinary tract symptoms. Multiple bladder areas were involved in 20 patien ts (65%), a single area was involved in 8 (26%), and diffuse involvement wa s present in 3 (10%), Twenty-four patients had immunoglobulin light chain, and 3 had transthyretin-related amyloid, Local recurrences were common None of the patients developed systemic amyloidosis. Conclusion: Primary localized amyloidosis of the urinary bladder can be eas ily confused with a neoplasm, Immunohistochemical amyloid typing is importa nt. Transthyretin-related amyloid of the bladder requires no further work-u p, Repeated work-ups for systemic amyloidosis are unnecessary for patients with light chain-related amyloidosis of the urinary bladder. Early eradicat ion with fulguration or laser therapy is indicated. Cystoscopic follow-up i s necessary.