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Primary isolated bladder lymphoma represents around 0.2% of all extranodal Non-Hodgkin-Lymphoma and less than 1% of all bladder tumours. Clinical representation may be unspecific and correct diagnosis is essential for the appropriate treatment. We expose the case of a patient with a primary B-cell bladder lymphoma with normal cystoscopy. Case report: A 67-year-old patient presented with lower urinary tract infections, overactive bladder with urinary incontinence as well as haematuria susceptible for bladder carcinoma. Urine sediment, cytologie, abdominaland kidney ultrasound as well as a CT scan did not lead to a conclusive diagnosis. Surprisingly, cystoscopy did not demonstrate any tumourous lesions and urine cytology revealed free of malignant cells. Cold four-quadrant cut biopsies finally did reveal the presence of a primary B-cell lymphoma. After a four weeks’ antibody treatment of Rituximab (Mabthera) the patient showed subjective improvement and lower urinary tract symptoms disappeared. Clinical follow-up as well as repeat cystoscopic biopsies were undertaken every six months. After a follow-up period of nearly three years the patient is still in complete remission. Urinary tract infections and incontinence as well as OAB symptoms disappeared entirely. Discussion: Haematuria was the main clinical finding in the current case of primary bladder lymphoma. Uneventful radiologic examinations lead to the necessity of bladder biopsies without any macroscopic pathologic findings. We present the exceedingly rare case of a primary bladder lymphoma without any characteristic lesions in the bladder lumen. For this reason, cystoscopic four quadrant biopsies should be used largely. Biopsies are essential leading to the correct diagnosis and finally successful treatment. Single antibody therapy with Rituximab is an option in selected cases as the one presented and can be used as un therapeutic option.

Case Report about a Primary Bladder Lymphoma