Leiomyosarcoma of the Urinary Bladder: A Case Report Highlighting Atypical Presentation and Literature Review

Objective: To report a rare case of bladder leiomyosarcoma with an atypical presentation, highlighting diagnostic challenges, management strategies, and the importance of incidental findings in early detection, with a review of relevant literature. Case: A 44-year-old female presented with mild, intermittent hematuria, incidentally detected during a dermatological evaluation for unrelated symptoms. Abdominal ultrasound revealed a 25 × 21 mm polypoid bladder mass, confirmed as leiomyosarcoma via MRI and cystoscopic biopsy. Histopathology showed a spindle cell mesenchymal tumor with atypical cells and a smooth muscle phenotype. The patient underwent radical cystectomy with pelvic lymph node dissection, achieving negative margins. No recurrence or metastasis was observed at the 6-month follow-up. Conclusion: This case underscores the diagnostic complexity of bladder leiomyosarcoma due to its rarity and subtle presentation. Incidental detection through imaging for unrelated conditions can lead to early diagnosis, improving prognosis. A multidisciplinary approach and thorough histopathological evaluation are critical for accurate diagnosis and effective management.