Cystoscopic Appearance of Bladder Hemangioma
Bladder hemangioma appears on cystoscopy as a sessile, blue or reddish, multilocular mass with a smooth or irregular surface, typically smaller than 3 cm and solitary in presentation. 1
Classic Cystoscopic Features
The characteristic appearance includes:
- Color: Blue to reddish hue, distinguishing it from typical urothelial lesions 1, 2
- Morphology: Sessile (flat-based) rather than papillary, with a multilocular appearance 1
- Surface: Can be smooth or irregular 1
- Size: Most lesions are smaller than 3 cm in diameter 1
- Number: Typically solitary, though multiple lesions can occur 1
- Location: Can occur anywhere in the bladder, including near the bladder neck 2
Important Diagnostic Considerations
The cystoscopic appearance alone is not pathognomonic, and histological confirmation is mandatory for definitive diagnosis. 1 This is critical because:
- The visual appearance may not always show typical features, even in confirmed cases 3
- The lesion must be distinguished from malignant bladder tumors, which is impossible by visual inspection alone 1
- Only histological examination showing numerous proliferative capillaries with thin-walled, dilated, blood-filled vessels lined with flattened endothelium confirms the diagnosis 1
Clinical Context
Patients typically present with painless gross hematuria once the lesion has eroded through the urothelium 1, 2. The reddish or blue elevated appearance on cystoscopy in a patient with recurrent painless hematuria should raise suspicion for hemangioma, though biopsy or resection with pathological examination remains essential 2.
Pitfalls to Avoid
- Do not rely on cystoscopic appearance alone for diagnosis, as atypical presentations occur and malignancy must be excluded 3
- Be aware that small or flat lesions may be missed on imaging but detected on cystoscopy 4
- Consider the bleeding risk when planning biopsy or resection of suspected vascular lesions 2, 5