Bladder Leiomyoma Presenting with Lower Urinary Tract Symptoms: A Rare Case Report

Abstract Bladder leiomyoma is a rare benign mesenchymal tumor that can closely simulate malignant bladder lesions due to its nonspecific clinical and radiological features. Consequently, it often poses a diagnostic challenge. Here, we present a case of a 44-year-old female who presented with lower urinary tract symptoms, including frequency, urgency, and a sensation of incomplete bladder emptying. Imaging demonstrated a well-circumscribed mass arising from the right anterolateral wall of the urinary bladder. Transurethral resection was performed. Histopathological evaluation revealed a well-defined spindle cell tumor composed of intersecting fascicles of cytologically bland cells without atypia, mitotic activity, or necrosis. Immunohistochemistry showed diffuse positivity for smooth muscle actin and desmin with a low Ki-67 index, confirming the diagnosis of bladder leiomyoma. This case underscores the importance of considering bladder leiomyoma in the differential diagnosis of bladder masses to avoid misinterpretation as a malignancy. Accurate diagnosis relies on histopathological and immunohistochemical evaluation, and complete surgical excision ensures excellent clinical outcomes.