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Deep endometriosis - urinary bladder

Diagnosis certain

Presentation

Suprapubic pain and recurrent urinary tract infections.

Patient Data

Age: 30 years
Gender: Female
ultrasound

There is a heterogeneous echogenicity area protruding into the posterior wall of the bladder. No clear tissue plane is identified between the anterior uterine wall and the posterior wall of the bladder.

An enhancing mass in the posterior wall of the bladder. The mass protrudes into the bladder and no clear fat plane is identified between the posterior wall of the bladder and the anterior uterine wall.

The right ovary is enlarged and shows heterogenous enhancement, representing previously diagnosed ovarian endometriosis.

The uterus is bulky. No pelvic lymphadenopathy or free fluid in the pelvis.

Soft tissue nodule in the right inguinal canal/canal of Nuck.

pathology

Macroscopy

Multiple brownish fragments of tissue together measure 2.5 x 2 x 0.5 cm.

Microscopy

Sections show fragments of bladder wall tissue covered by unremarkable urothelium. The lamina propria and muscle wall show scattered cystically dilated endometrial type glands surrounded by endometrial type stroma. Fresh haemorrahges and hemosiderin laden macrophages are seen. The lamina propria is edematous. There is no malignancy.

Diagnosis

Endometriosis of bladder.

Case Discussion

Bladder involvement is a rare presentation of endometriosis. Invasion of the detrusor muscle is defined as bladder endometriosis. The nodule in the right inguinal canal/canal of Nuck is also presumably an endometriotic deposit. This patient had a known history of endometriosis.

The most frequent presentation is urgency, frequency, suprapubic pain, hematuria, dysuria, and/or urge incontinence. Most of the symptoms are cyclic in nature.

Ultrasound scans and MRI are the most important radiological investigations in the evaluation of suspected bladder endometriosis.

Treatment consists of surgical resection, either by laparotomy or laparoscopy.

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