Isolated peripheral nerve sheath tumour involving the urinary bladder neck

A 33-year-old male presented in the urology outpatient clinic with symptoms of intermittent macroscopic haematuria, frequency, urgency and occasional significant hesitancy lasting for six months. Past medical or relevant family history was absent. Physical examination was unremarkable and digital rectal examination (DRE) revealed a small, smooth prostate. Patient underwent an ultrasound (US) and X-ray kidneys – ureters – bladder (KUB) which came back normal, and we proceeded with a flexible cystoscopy. It revealed an enlarged and irregular bladder neck but otherwise normal appearances (Figure 1). Uroflow studies showed a Q max up to 17.2 ml/s with minimal residual postmicturition volumes. Subsequently, patient had a cystoscopy under general anaesthetic (GA), bladder neck resection and received a single dose of intravesical mitomycin. Histological analysis revealed a benign peripheral nerve sheath tumour, strongly immunoreactive to S-100 antibody, features of hybrid lesion of overlapping neurofibroma and schwannoma (Figure 2). Our patient had a repeat flexible cystoscopy after six months which showed re-growth of the tumour but as he was asymptomatic and for personal preferences he opted not to have any treatment then. Eighteen months later a repeat flexible cystoscopy confirmed tumour enlargement (Figure 3). The patient underwent repeat resection under GA and the histological diagnosis confirmed residual peripheral nerve sheath tumour. A follow-up flexible cystoscopy revealed re-growth of the tumour (Figure 4). Therefore, radical bladder neck resection was proposed but the patient opted for conservative management. He is currently followed-up with flexible cystoscopies.