British Journal of Urology (1998), 82, 134–135

CASE REPORT

Pedunculated mesenteric leiomyoma masquerading as aretrovesical mass lesion: a diagnostic dilemmaN.P. GUPTA, M. ARON and S. SOODDepartment of Urology, All India Institute of Medical Sciences, New Delhi, India

soft-tissue mass posterolateral to the urinary bladder,Case reportwith an attenuation value of 41.6 Hounsfield units.There was no lymphadenopathy; seminal vesicles, pros-A 30-year-old man presented with pain in the right

groin of 6 months’ duration. Physical examination tate, vasa deferentia and the rest of the viscera werenormal. Cystoscopy revealed a bulge on the right postero-revealed no abnormality; both testes were descended and

normal. An ultrasonogram (Fig. 1) showed a solid mass lateral wall of the bladder. The right ureteric calculuswas retrieved ureteroscopically and a laparoscopy carriedbehind the right posterolateral wall of the urinary blad-

der, and right hydroureteronephrosis. Subsequently, IVU out under the same anaesthesia. This revealed a 3×4 cmrounded, well-circumscribed mass with flimsy adhesions,and CT (Fig. 2) revealed a right ureteric calculus at the

fourth lumbar vertebral level and a single 3×4 cm deeply wedged in the rectovesical pouch. On laparoscopicmobilization, it became apparent that it was a peduncu-lated mass, arising from the small bowel mesentery. Thepedicle was clipped and divided at its base, and thetumour delivered intact through a 10 mm port site. Thehistology was a benign leiomyoma. After 2 years offollow-up the patient is completely asymptomatic withno evidence of recurrence.

Comment

Causes of solid retrovesical mass lesion in males includeteratomas and other tumours of germ cell origin,tumours of the spine and spinal cord, benign and malig-nant soft tissue tumours, and tumours of the seminalvesicles, lymph nodes and Mullerian duct remnants [1].Most solid tumours of the mesentery in adults areFig. 1. An ultrasonogram showing a solid mass behind the right

posterolateral wall of the bladder. metastatic and primary tumours of the mesentery arerare [2]. Yannopoulos and Stout [3] studied 44 primarysolid tumours of the mesentery, two-thirds of whichwere benign and seven of smooth muscle origin. Othersolid primary tumours of the mesentery includeCastleman’s disease, carcinoid tumour and germ-celltumours [2]. To the best of our knowledge, this is thefirst case report of a pedunculated mesenteric leiomyomapresenting as a retrovesical mass of obscure aetiology.Where current radiological studies fail to provide adiagnosis in a patient with a retrovesical mass, laparos-copy may help to resolve the diagnostic dilemma andeven prove therapeutic.

Fig. 2. A CT scan showing the same lesion with an attenuation of41.6 Hounsfield units.

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References AuthorsN.P. Gupta, MS(Surg), MCh(Urol), Professor of Urology.1 Ney C, Friedenberg RM. Displacement of the bladder. In

Radiographic Atlas of The Genitourinary System. 2nd edn., M. Aron, MS(Surg), DipNB(Surg), MCh(Urol) Senior Resident.S. Sood, MS(Surg), Senior Resident.Vol. 2. Philadelphia: J.B. Lippincott Co., 1981: 1375

2 Rosai J. Peritoneum, retroperitoneum and related structures. Correspondence: Professor N.P. Gupta, Department of Urology,All India Institute of Medical Sciences, New Delhi 110029,In Ackerman’s Surgical Pathology. St Louis: Mosby-Year Book,

1996: 2153 India.3 Yannopoulos K, Stout AP. Primary solid tumors of the

mesentery. Cancer 1963; 16: 914

© 1998 British Journal of Urology 82, 134–135