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+A 38-year-old man, with hepatitis B as the only personal history of interest, presented with a picture of pollakiuria and bladder urgency of 11 months' duration accompanied by terminal haematuria without clots.
+On physical examination, the abdomen was soft and depressible with no visceromegaly or other abnormalities. On rectal examination, the prostate had a volume of I/IV, was elastic, ill-defined and almost flat. Genitalia were normal.
+Blood tests with haemogram, biochemistry, coagulation and PSA within normal parameters. Urinalysis with pH 5.5. Urine sediment with 15-20 leucocytes/field and abundant mucus. Urine culture was sterile.
+Urine cytology was negative for malignant tumour cells and renal, bladder and prostate ultrasound found no alterations, the prostate being homogeneous, with well-defined contours, measuring 17 x 20 mm.
+Intravenous urography showed normal kidneys and ureters, and a displacement of the bladder to the left and above by a subvesical pelvic mass (with no appreciable bladder filling defects). Cystourethrography showed extrinsic bladder compression.
+
+Cystoscopy showed no endovesical changes. The abdominal-pelvic CT scan showed a large pelvic mass anterior to the bladder, measuring 12 cm in diameter, with well-defined contours, which displaced the bladder backwards and to the left, and the bowel loops cranially, with a fatty plane separating the mass from the bladder. After contrast administration the mass became denser.
+
+Since its origin was not clear, MRI was performed, confirming that it measured 8x12x13cm, well defined, located in front of the bladder and rejecting the bladder to the back and to the left. The mass formed lobulations and was delimited by a thin capsule. The diagnostic suspicion on MRI was fibroadenoma of the urachus due to its lobulated appearance and the presence of fibrous tissue with nodular areas that were enhanced by the injection of IV contrast.
+
+The FNA diagnosis was 'morphologically benign tumour, probably adenomatoid'.
+In view of the findings described above, it was decided to remove the tumour. On bimanual palpation, the mass was mobile on prostatic compression. Through a median infraumbilical incision and extraperitoneal access, a pelvic mass was identified to the right of the bladder, which appeared to be dependent on the anterior prostatic aspect. After opening the endopelvic fascia, the thin prostatic pedicle on which the mass was dependent was sectioned. Intraoperative biopsy was reported as malignant epithelial tumour with intense reactive fibrosis. Prostatectomy was not performed pending a definitive diagnosis, as macroscopically it appeared benign.
+
+The histopathological study described, macroscopically, a nodular tumour with a smooth surface measuring 12.5 x 12.5 x 7 cm, weighing 50 g. One of its edges was covered by a small, irregularly shaped lump. On one of its edges there was a thin pedicle 0.7 mm long. Microscopically it was composed of a proliferation of spindle cells without atypia in variable numbers, adopting in some areas a haemangiopericytoid-like pattern, associated with a large differentiation of thick collagen bundles predominating in the tumour. There were very isolated foci of atypical cells with <4 mitoses/10 high magnification fields. The pedicle had arterial and venous structures surrounded by connective tissue within which nests with fibroblastic differentiation were identified. Immunohistochemistry showed positivity for CD34, D99 and vimentin, focally positive anti-desmin and broad spectrum keratins, negative cytokeratin 7, EMA, actin, enolase, S-100, chromogranin and p53. The tumour proliferation index expressed by Ki67 was less than 1%.
+The definitive diagnosis was solitary fibrous tumour.
+After three years of follow-up the patient has no recurrence of the disease on MRI and is asymptomatic.
+