Primary localized amylodoisis of bladder: Is there a need for cystoscopic surveillance?
A 71-year-old gentleman was referred to hematuria clinic for his single episode of visible painless haematuria. There was no history of lower urinary tract symptoms and no previous urological problems. He had dipstick hematuria and urine cytology was reported as benign. His ultrasound scan of kidneys and bladder revealed thickened posterior bladder wall and small simple renal cysts bilaterally. At flexible cystoscopy a solid lesion on the posterior bladder wall resembling invasive bladder was seen []. Transurethral resection was performed and the specimen was submitted for histopathological examination. Final histology reported a primary amyloidosis of AL type. A thorough systematic investigation including rectal biopsy, bone marrow biopsy and SAP (serum amyloid P component) scintigraphy showed no evidence of systemic amyloidosis. Three years from his initial diagnosis a small urethral lesion was noted which was biopsied and histology confirmed it as primary amyloid of AL type []. Since then he has remained asymptomatic without progression of vesical amyloidosis.