Asian Journal of Advanced Research and Reports

Background: Angiosarcoma of the bladder is a rare and aggressive malignancy arising from malignant endothelium accounting for less than 2% of all sarcomas. It typically affects older adults, with few cases reported in younger individuals. The rarity and nonspecific clinical presentation make diagnosis and management particularly challenging.

Case Presentation: We report the case of a 32-year-old female who presented with life-threatening haematuria and anaemia. Initial assessment suggested bladder clots, and diagnostic cystoscopy was inconclusive due to persistent bleeding and extensive clot formation. The patient underwent emergency laparotomy, during which a biopsy from the thickened bladder wall revealed angiosarcoma though, immunohistochemistry was not available creating a diagnostic limitation. Despite aggressive resuscitation, and internal iliac artery ligation, bleeding persisted. Once stabilised, the patient underwent an open radical cystectomy with ileal conduit diversion. Postoperative recovery was initially uneventful, but the patient later succumbed to complications from anaemia and multi-organ failure within three months of diagnosis.

Discussion: This case highlights the aggressive course of bladder angiosarcoma and underscores the importance of early recognition and intervention. Due to its rarity, especially in young females without known risk factors, diagnosis is often delayed. Histopathological and immunohistochemical evaluation remain crucial for definitive diagnosis. Management requires a multimodal approach, often including radical surgery, and possibly chemotherapy or radiotherapy depending on the disease stage. Despite timely intervention, prognosis remains poor with high mortality.

Conclusion: Bladder angiosarcoma, although rare, should be considered in the differential diagnosis of unexplained haematuria, even in young patients. Prompt diagnosis and radical treatment are vital, although the prognosis remains guarded.