Postoperative spindle cell nodule of the urethra and bladder in a 90-year-old male: A diagnostic challenge

Postoperative spindle cell nodule is a rare benign reactive lesion of the genitourinary tract that can closely mimic malignant spindle cell neoplasms. We report a 90-year-old male with recurrent urethral obstructions and bladder lesions over four years following repeated instrumentation for urethral strictures. Multiple cystoscopies revealed recurrent masses (2-5 cm) throughout the urethra and urinary bladder. Initial biopsies were nondiagnostic. The final histopathological examination demonstrated fibrosis, edema, inflammation, and atypical spindle cells without mitosis or necrosis. Immunohistochemistry showed positivity only for Vimentin and p53, with all lineage-specific markers negative. In view of the clinical course and the pathological findings, postoperative spindle cell nodule was diagnosed. This case emphasizes the diagnostic challenge of distinguishing benign pseudosarcomatous reactive lesions from true malignancy in elderly patients with recurrent urinary tract masses following instrumentation.