What are the other Names for this Condition? (Also known as/Synonyms)

• Postoperative Pseudosarcoma of Urinary Bladder
• Postoperative Spindle-Cell Nodule of Bladder
• PSCN of Urinary Bladder

What is Postoperative Spindle-Cell Nodule of Urinary Bladder? (Definition/Background Information)

• Postoperative Spindle-Cell Nodule of Urinary Bladder is a rare and benign tumor that forms due to an injury (tissue damage); particularly because of a surgical procedure involving the genitourinary tract. It is generally observed in middle-aged and older individuals
• Postoperative Spindle-Cell Nodule of Urinary Bladder can appear within a few weeks to a few months following the surgical procedure. It forms at the site of the surgery as a benign reactive lesion
• The tumor is also known as a postoperative pseudosarcoma, since it resembles a sarcoma, which is a malignant tumor. This can lead to misdiagnosis and over-treatment of Postoperative Spindle-Cell Nodule of Bladder. For this reason, it is important that a healthcare provider carefully examine and recognize the tumor (i.e., postoperative spindle-cell nodule or PSCN)
• The tumor appears as a solitary nodule with poorly or well-defined borders. These tumors are frequently associated with bleeding. In some cases, blood in urine may be observed
• The treatment course may include a ‘wait and watch’ approach or a surgical excision and removal of the lesion. In general, the prognosis of Postoperative Spindle-Cell Nodule of Urinary Bladder is excellent with suitable treatment, but the tumor is known to recur locally

Who gets Postoperative Spindle-Cell Nodule of Urinary Bladder? (Age and Sex Distribution)

• Postoperative Spindle-Cell Nodule of Urinary Bladder is a rare tumor that is generally observed in middle-aged and older individuals (age 40-85 years)
• Rarely, the tumor has been noticed in children
• Both males and females may be affected by this tumor type. Generally, males are affected slightly more than females in a 3:2 ratio
• There is no known ethnic or racial preference

Overall, considering the general incidence of PSCN, it is more common in males than females with a male-female ratio of 3:1.

What are the Risk Factors for Postoperative Spindle-Cell Nodule of Urinary Bladder? (Predisposing Factors)

Any surgical procedure performed involving the urinary bladder can be a potential risk factor for Postoperative Spindle-Cell Nodule of Urinary Bladder. Such invasive procedures may include any of the following:

• Transurethral resection (TUR): It is a urological procedure, frequently used to treat urinary bladder cancer or advanced cases of prostate cancer in men. Sometimes, repeat procedures are undertaken
• Biopsy procedure involving the urinary bladder or pelvic region

A past history of postoperative spindle-cell nodule either at the same site or other location may increase the risk; this implies that some individuals are more prone to development of this reactive tumor.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Postoperative Spindle-Cell Nodule of Urinary Bladder? (Etiology)

• Currently, the exact cause and mechanism of formation of Postoperative Spindle-Cell Nodule of Urinary Bladder is unknown
• The tumors are seen to form as a reactive process at the site of surgical injury or trauma

What are the Signs and Symptoms of Postoperative Spindle-Cell Nodule of Urinary Bladder?

The signs and symptoms of Postoperative Spindle-Cell Nodule of Urinary Bladder may include:

• Small tumors usually do not cause any symptoms and may remain unnoticed/undetected
• The reactive lesions (fibrous tissue) form at the site of trauma/surgery and can be nodular in shape. The lesions are known to grow and develop rapidly
• In a majority of cases, the time period between the surgical procedure and formation of the reactive lesion in the bladder ranged from 1-10 weeks. In some cases, the lesion was observed to form even after a year
• The borders of the nodules may be well-defined or irregularly-defined
• The size of the tumors may be around 2 cm (range 5 mm to 10 cm); some are polypoid in nature
• Some may be swollen with fluid; many lesions are known to bleed (hemorrhage)
• Blood in urine (hematuria) may be seen in a few cases
• Painful urination

Note: But for metastasis, a postoperative spindle-cell nodule is similar to a sarcoma (a malignant tumor with infiltrative margins) both in behavior and on a histopathological evaluation.

How is Postoperative Spindle-Cell Nodule of Urinary Bladder Diagnosed?

A diagnosis of Postoperative Spindle-Cell Nodule of Urinary Bladder may involve the following steps:

• Complete physical and pelvic examination and evaluation of the individual’s medical history: In order to establish a diagnosis of a Postoperative Spindle-Cell Nodule of Bladder, a history of a prior surgical procedure/operation at the site of the tumor is key
• Plain X-ray of the abdomen
• Ultrasound scan of the abdomen
• CT or CAT scan with contrast of the abdomen may show the presence of a mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
• MRI scans of the abdomen: Magnetic resonance imaging (MRI) uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
• Cystoscopy: During a cystoscopy, a narrow tube called a cystoscope is inserted to look directly into the bladder. A local anesthetic is usually administered, in order to make the examination more comfortable
• Ureteroscopy: Endoscopic study of the upper urinary tract using an endoscope inserted through the urethra
• Intravenous pyelogram (IVP): Intravenous pyelogram is a technique using X-rays, to examine the kidneys, bladder, and ureters (the tubes that transport urine from the kidneys to the bladder), by using a dye to highlight the duct systems. Any signs of abnormalities can be visualized using an IVP

Invasive diagnostic procedures such as:

• Laparoscopy: A special device is inserted through a small hole into the abdomen, to visually examine it. If necessary, a tissue sample is obtained for further analysis. Exploration of the abdomen using a laparoscope is called ‘exploratory laparoscopy’
• Laparotomy: The abdomen is opened through an incision for examination, and if required, a biopsy sample obtained. Exploration of the abdomen using laparotomy procedure is called ‘exploratory laparotomy’

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment. The tissue for diagnosis can be procured in multiple different ways which include:

• Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Core biopsy of the tumor
• Open biopsy of the tumor

Tissue biopsy:

• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Note:

• A Postoperative Spindle-Cell Nodule of Bladder shows sarcomatoid features (sarcoma resemblance), both in terms of behavior and morphologically. The healthcare provider should be aware of such tumors and the nature of these tumors, in order to make an accurate diagnosis. Otherwise, it can lead to an incorrect diagnosis and over-treatment of this benign tumor
• A postoperative spindle-cell nodule (PSCN) is also known to be histologically similar to inflammatory myofibroblastic tumor (IMT). IMTs are benign tumors with aggressive behavior that can occur anywhere in the body. However, unlike PSCNs, IMTs are not seen against a background of trauma

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Postoperative Spindle-Cell Nodule of Urinary Bladder?

Significant complications from Postoperative Spindle-Cell Nodule of Urinary Bladder are generally not noted. However, the following may be observed in some cases:

• Stress due to a concern for bladder cancer
• Occasionally, obstruction of the urinary bladder
• Tumor masses may get secondarily infected with bacteria or fungus
• Providing inappropriate or ineffective treatment due to misdiagnosis of the tumor as a sarcoma
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication
• Local recurrence of the tumor after its surgical removal is known to occur

How is Postoperative Spindle-Cell Nodule of Urinary Bladder Treated?

Treatment measures for Postoperative Spindle-Cell Nodule of Urinary Bladder may include the following:

• Majority of asymptomatic tumors are not surgically removed: The healthcare provider may recommend a ‘wait and watch’ approach for small-sized tumors presenting mild (or no) signs and symptoms, after a diagnosis of postoperative spindle-cell nodule is established
• Surgical intervention with complete excision may result in a complete cure. The surgical procedures undertaken may include the following
  • Any bladder-sparing surgery, to the extent possible
  • Transurethral resection or removal of tumor tissue from the bladder
  • A partial or radical cystectomy (removal of the urinary bladder)
• Advanced surgical techniques may help decrease the incidence of recurrence after removal of the lesion
• Post-operative care is important: Minimum activity level is to be ensured until the surgical wound heals
• Follow-up care with regular screening may be recommended by the healthcare provider

How can Postoperative Spindle-Cell Nodule of Urinary Bladder be Prevented?

• The development of reactive lesions, such as due to surgical trauma, is difficult to predict. Currently, no specific measures are available to prevent the formation of Postoperative Spindle-Cell Nodule of Urinary Bladder
• However, prompt treatment may help in decreasing the amount of fibrous tissue formation at the site of surgery

What is the Prognosis of Postoperative Spindle-Cell Nodule of Urinary Bladder? (Outcomes/Resolutions)

• The prognosis of Postoperative Spindle-Cell Nodule of Urinary Bladder is excellent with appropriate treatment, since it is a benign tumor
• However, the tumor is known to locally recur, and hence, close follow-up may be necessary

Additional and Relevant Useful Information for Postoperative Spindle-Cell Nodule of Urinary Bladder:

The following DoveMed website links are useful resources for additional information:

http://www.dovemed.com/healthy-living/womens-health/

http://www.dovemed.com/diseases-conditions/cancer/