A case of severe bladder wall hypertrophy: bladder cancer or sequela of bladder outlet obstruction?

Angiosarcomas are soft tissue malignancies of connective tissue origin with rapid hematogenous spread, but are extremely uncommon primary tumors of the bladder with approximately ten reported cases in the 20th century. We report a 59-year-old man with benign prostatic hyperplasia (BPH) and gross hematuria who underwent a bladder biopsy for a markedly thickened bladder wall on CT scan. Biopsy specimens demonstrated deep vascular malformations that were concerning for a malignancy. Intense pathological review was initially not definitive and transurethral resection of the prostate (TURP) was performed for his symptoms. Interestingly, surgery reversed the bladder process. This case serves as a unique example of how the sequelae of bladder outlet obstruction (BOO) can resemble a malignant process on presentation but represent no more than hypertrophic adaptations in the bladder wall musculature of a patient with BPH and significant outlet obstruction.