Presentation
Gross hematuria. Evaluate with renal mass protocol.
Patient Data
Along the posterior bladder dome and wall is a lobulated mass that measures approximately 2.8 x 5.0 x 2.1 cm. The mass is superior to the trigone and is without evidence of involvement of the ureterovesicular junctions. Additionally, there is additional asymmetric thickening of the left anterolateral bladder wall. Excluding the bladder, there are no filling defects within the proximal renal collecting systems. However, there is poor opacification of the proximal and mid left ureter.
There is an indwelling Foley catheter. The kidneys are normal in size and attenuation. No renal calculi or hydronephrosis.
Other findings include a gastrojejunostomy tube coiled within the stomach. The tip terminates in the gastric antrum. There is a small duodenal diverticulum and colonic diverticulosis without diverticulitis. There is a left upper quadrant stoma without emptying bag seen, possibly related to old ileostomy, but a tract in the abdominal wall remains open.
Case Discussion
This is a case of transitional cell carcinoma of the bladder. The patient received a robotic radical cystectomy, bilateral pelvic lymph node dissection, and total hysterectomy with salpingo-oophorectomy. Pathologic examination revealed urothelial carcinoma with extensive glandular differentiation that was invasive to the lamina propria. There were several areas of focal atypia or non-keratinizing squamous metaplasia of the urothelium. The dissected lymph nodes were negative.
She was discharged from hospital to home on post-operative day 20 without complication.
CO-AUTHORS:
Alannah McCann
Christine Cooley, MD
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