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+We present the case of a 30-year-old woman, smoker of 20 cigarettes/day and with no other personal history of interest. The patient reported repeated urinary tract infections. An abdominal ultrasound scan was indicated and an intravesical nodular lesion was observed, for which she was referred to the urology department.
+Cystoscopy showed an exophytic tumour measuring 3x3 cm on the right lateral side with intact bladder mucosa, and no alterations were found in the rest of the bladder. Examination under anaesthesia (EBA) and transurethral resection of the lesion (TUR) were performed.
+The pathological anatomy report described macroscopically fragments of bladder wall with preserved urothelium without dysplasia, highlighting in the muscular layer itself and in continuity with the muscle tissue of the same, a spindle cell tumour with cells showing large nuclei, pleomorphic, vesicular in appearance and large eosinophilic cytoplasm. This cellularity is arranged in ill-defined fascicles and among it there is abundant cellularity consisting mainly of numerous plasma cells and eosinophilic polymorphonuclear leukocytes. A high mitotic index is not observed, although the proliferation index measured as nuclear positivity with antibodies against MIB-1 is between 10 and 25% of the tumour cellularity. No areas of necrosis were observed. Immunohistochemistry showed marked positivity against cytokeratins (AE1/AE3) and CAM5.2 at the cytoplasmic level, as well as marked cytoplasmic positivity with antibodies against p80 (ALK protein). The cellularity described was negative for smooth muscle antibodies (smooth muscle actin, MyO D1 and Calretininin), as well as for CEA and high molecular weight cytokeratins, with only focal and isolated positivity for EMA. FISH on paraffin-embedded material showed no evidence of translocation in the ALK gene.
+The definitive anatomopathological diagnosis is inflammatory myofibroblastic bladder tumour.
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+