Management of Inflammatory Myofibroblastic Tumor of Urinary Bladder With Partial Cystectomy: A Case Report

Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms that can mimic malignant bladder tumors both clinically and radiographically. We report the case of a 46-year-old woman who presented with recurrent episodes of gross hematuria and clot retention. Imaging revealed a 6.2 cm bladder mass at the anterior dome without metastatic disease. She underwent transurethral resection, and pathology demonstrated a spindle cell neoplasm expressing anaplastic lymphoma kinase (ALK), desmin, and smooth muscle actin, while fluorescence in situ hybridization confirmed ALK gene rearrangement. Despite initial endoscopic management, persistent hematuria required a robotic-assisted partial cystectomy, which achieved complete resection with negative margins. The patient recovered well, and follow-up imaging and cystoscopy at six months demonstrated no recurrence.  This case highlights the diagnostic and management challenges of bladder IMTs, which often present with features that overlap with other malignancies of the bladder. While generally considered tumors of intermediate biologic potential, complete surgical excision remains the cornerstone of management. Bladder-sparing approaches, such as partial cystectomy, are effective in select patients and offer excellent outcomes when negative margins are achieved.