Primary amyloidosis of the urinary bladder presenting as painless heamaturia

A case of primary amyloidosis of urinary bladder was presented with painless heamaturia and irritative urinary symptoms. Radiological imaging showed multiple small masses within the urinary bladder with suspicion of multiple transitional cell carcinomas within the urinary bladder. Cystoscopy confirmed the multiple masses within the urinary bladder, some showing haemorrhagic papules and papillary projections over the masses. Histopathology of the biopsy material was negative for the malignancy. Immunostaining of the biopsy material with Congo red stain showed the presence of amyloid fibrils within the biopsy material. Further investigations of systemic illness exclude the secondary amyloidosis. Transurethral resection was done. Patient showed improvement after the resection and no recurrence was observed during follow up. The purpose of this case presentation is to create awareness among the urologists to think for the rare entity of urinary amyloidosis especially if the histopathology is negative for the malignant cells.