The Mystical Recurrent Bladder Polyp

Background: Bladder cancer recurrence is a common concern following transurethral resection procedures, and any new lesion at a prior surgical site is typically viewed with high suspicion for malignancy. However, certain benign conditions can closely mimic recurrent cancer, potentially leading to misdiagnosis and unnecessary interventions. This case report presents an uncommon instance of a bladder stone (cystolith) masquerading as a recurrent tumor at the site of a previous transurethral resection, highlighting the importance of histopathological confirmation in surveillance. Case presentation: An 80-year-old male with a prior history of low-grade bladder cancer, managed with transurethral resection, was found to have a new polypoid lesion at the surgical scar site during routine follow-up cystoscopy. The lesion measured 1.5 × 1.5 centimeters and was located on the right posterolateral wall of the bladder. Given the patient’s oncologic history, the clinical suspicion was high for tumor recurrence. Laboratory investigations revealed poorly controlled diabetes but no hematuria or urinary tract infection. Urinary cytology was negative for malignant cells. The lesion was biopsied during cystoscopic examination. Histopathological evaluation demonstrated necrotic material with crystalline structures, a foreign body-type giant cell reaction, and an absence of neoplastic cells. Polarizing microscopy revealed rosette-like and spiky birefringent crystals consistent with a bladder calculus. The patient was reassured, and no further oncological intervention was required beyond standard follow-up. Conclusions: This case illustrates a rare but significant diagnostic pitfall where a benign bladder stone mimicked cancer recurrence. It underscores the vital role of biopsy and histopathological examination in distinguishing between benign and malignant lesions, particularly in patients with a known history of bladder cancer. Clinical vigilance, coupled with confirmatory diagnostics, is essential to avoid overtreatment and ensure accurate long-term surveillance planning.