Primary Extranodal Non-Hodgkin Lymphoma of the Urinary Bladder: A Case Report
Authors & Affiliations
- Department of Urology, Institute of Kidney Diseases, Peshawar, Pakistan.
- The Operating Room Global (TORG).
Corresponding author: Dr. Abdul Haseeb · [email protected]
Abstract
Background: Primary extranodal non-Hodgkin lymphoma (NHL) of the urinary bladder is an exceptionally rare malignancy, accounting for less than 0.2% of extranodal lymphomas. Its clinical and radiological features often mimic urothelial carcinoma, making diagnosis challenging.
Case Presentation: A 50-year-old male presented with a six-week history of painless gross hematuria, dysuria, increased urinary frequency, and intermittent left flank pain. He had no constitutional symptoms suggestive of systemic lymphoma.
Clinical Findings and Investigations: Ultrasonography and CT intravenous urography revealed an irregular bladder mass involving the left lateral wall and vesicoureteral junction, causing severe left hydroureteronephrosis. Cystoscopy demonstrated papillary and sessile bladder lesions. Following transurethral resection of the bladder tumor (TURBT), histopathology with immunohistochemistry confirmed diffuse large B-cell lymphoma (DLBCL) of the urinary bladder.
Intervention and Outcome: The patient received six cycles of R-CHOP chemotherapy, achieving marked clinical and radiological regression. Follow-up PET-CT and repeat TURBT showed complete remission with no evidence of recurrent disease. Repeat biopsy revealed only mild chronic cystitis.
Conclusion: Primary bladder DLBCL is a rare but important differential diagnosis of bladder tumors. A definitive diagnosis relies on histopathological and immunohistochemical evaluation. Early recognition and treatment with R-CHOP chemotherapy can result in excellent clinical outcomes while avoiding unnecessary radical surgery.
Keywords: Primary bladder lymphoma; diffuse large B-cell lymphoma; extranodal non-Hodgkin lymphoma; hematuria; urinary bladder; R-CHOP.
Case Presentation
A 50-year-old male farmer attended a urology outpatient department with approximately six weeks of painless visible hematuria, sometimes with clots, accompanied by dysuria, urinary frequency and intermittent dull left-flank pain. He reported no smoking history, fever, weight loss, night sweats or other constitutional symptoms.
Examination showed hemodynamic stability without pallor, palpable lymphadenopathy or hepatosplenomegaly. Routine hematological, coagulation, liver, renal and electrolyte tests were within normal limits. HIV, hepatitis B surface antigen and hepatitis C serology were non-reactive. Urinalysis revealed 15–20 leukocytes per high-power field and numerous red blood cells.
Investigations & Diagnosis
| Investigation | Published finding |
|---|---|
| Ultrasonography | Irregular mass of the left lateral bladder wall extending to the left vesicoureteral junction, with severe left hydroureteronephrosis. |
| CT intravenous urography | Bladder mass involving the left vesicoureteral junction; gross left hydroureteronephrosis and enlarged left external iliac nodes. |
| Cystoscopy | Papillary lesions involving both lateral prostatic lobes; sessile lesions at the bladder neck, left lateral wall and left vesicoureteral junction. |
| TURBT and histopathology | Large atypical lymphoid cells consistent with diffuse large B-cell lymphoma of the urinary bladder. |
| Immunohistochemistry | CD20 and LCA positive; CD3 negative; Ki-67 approximately 50–60%, as labelled in Figure 3 of the publication. |
The published Figure 1 shows a CT-IVU image of the approximately 4 × 5.8 cm mass. Figures 2 and 3 present histopathology and immunohistochemistry. The original clinical images and captions are available in the published PDF (page 102); they are not reproduced or embedded on this webpage.
Treatment & Follow-up
Post-treatment assessment
Imaging three months after treatment initiation showed marked reduction of the bladder lesion. Subsequent PET-CT demonstrated diffuse bladder-wall thickening without metabolically active residual disease. Repeat cystoscopy found mildly hyperemic mucosa and no visible recurrence; biopsies from the previous resection site showed mild acute-on-chronic cystitis without residual lymphoma.
Discussion & Clinical Implications
Primary bladder lymphoma is exceptionally uncommon and may present with hematuria and irritative urinary symptoms indistinguishable from other bladder tumors. Imaging and cystoscopy help locate and assess the lesion, but histopathology and immunohistochemistry are essential for establishing the diagnosis.
The report highlights the importance of distinguishing primary bladder DLBCL from urothelial carcinoma and other malignant conditions. The patient’s favorable response to R-CHOP illustrates the potential for effective systemic treatment after tissue confirmation, rather than proceeding directly to radical bladder surgery.
Conclusion: Clinicians should consider lymphoma in the differential diagnosis of atypical bladder masses. Early recognition and appropriate pathological assessment may facilitate timely, organ-preserving treatment. As a single case report, these findings do not establish comparative treatment effectiveness or general outcomes for all patients.
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Declarations & Ethics
Ethical approval: Obtained from the Research and Ethical Committee, approval number 496/chairman/R&E/Committee/IKD.
Patient consent: Written informed consent was obtained for publication of the case report and accompanying images. A copy is available on request, according to the published report.
Funding: The report received no funding from any person or institution.
Competing interests: The authors declared no conflicts of interest.
Acknowledgements: None.
Author contributions: Jamal Ahmad Shah and Abdul Haseeb drafted the manuscript; Abdul Haseeb, Liaqat Ali and Rafaqat Hussain supervised the work; Raza Muhammad and Immad Ahmed critically reviewed the manuscript. All authors approved the final manuscript.
Publication Information
Accepted: 20 October 2026
Available online: 25 October 2026
ISSN 3105-3262
Volume 2, Issue 4 (December 2026), pp. 100–104
Creative Commons Attribution 4.0
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