Presentation
Painless macroscopic hematuria.
Patient Data
The urinary bladder shows a slightly lobulated wall-based solid mass lesion on the right side without calcification or necrosis.
Previously identified intra-vesical lesion is confirmed, as a well-defined oval-shaped enhancing mass lesion located in the right posterior wall of the bladder at the right vesicoureteric junction.
No hydronephrosis or hydroureter bilaterally. No evidence of solid renal masses.
No retroperitoneal lymphadenopathy. No liver or bone metastasis. No mesorectal lymphadenopathy.
Pelvic MRI with DWI obtained for accurate staging.
The previously seen intravesical lesion at the right posterolateral wall at the right vesicoureteric junction demonstrated strong diffusion restriction at B value 1200 indicating a malignant tumor with invasion of the wall of the bladder from outside suggesting that the tumor is at the end of the right ureter, mostly transitional tumor.
There is no evidence of significantly enlarged lymph nodes around the tumor and there is no evidence of enlarged lymph nodes in the mesorectum.
The arrow points towards the pathology.
Case Discussion
Transitional cell carcinoma is the most common primary neoplasm of the urinary bladder and the entire urinary system. Hematuria is the most common presenting complaint, which may be macroscopic or microscopic. A tumor located at the vesicoureteric junction may result in ureteral obstruction and hydronephrosis, which may present with flank pain.
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