Presentation
Right flank pain and loss of weight.
Patient Data
Well-delineated nodular opacity in the right upper lobe of unknown clinical significance.
The bone window of the chest demonstrates an enlarged calcified right costochondral joint of the first rib that could mimic a lung metastasis on the chest x-ray.
Right hydronephrosis secondary to an extensive bladder malignancy with obstruction of the ureter at the VUJ. There may also be blood clot within the bladder lumen. Right perinephric fluid collection extending along the right psoas muscle.
Cystoprostatectomy performed
MACROSCOPY:
Specimen A labelled 1. urinary bladder consists of an unoriented radical cystoprostatectomy with only a portion of the prostate noted inferiorly. Both ureters have been submitted separately. It measures from superior to inferior one hundred and ten millimetres, from left to right ninety-two millimetres, and from anterior to posterior sixty-two millimetres. The portion of the prostate measures twenty-one by twenty-four by twenty-two millimetres. A clip is noted on the right side, with a suture on the posterior left side, presumed to be where the ureters entered. Specimen anatomically orientated.
On anterior opening of the bladder, a tumour is noted predominantly inferiorly and anteriorly. The tumour measures from anterior to posterior forty-eight millimetres, from superior to inferior fifty-five millimetres, and from left to right sixty-two millimetres. The prostate shows no gross involvement by the tumour. The bilateral trigones are not seen as they are covered by the tumour. The tumour centre is necrotic and haemorrhagic. The fundus of the bladder is entirely spared, and the closest margin appears to be anterior, with a clearance of four millimetres. From superior, it measures forty-five millimetres, and from the inferior prostatic resection margin, twenty-four millimetres.
Case Discussion
Bladder cancer can present with flank pain due to haematuria and clot colic or due to obstruction of the VUJ by tumour. Perinephric collections can be caused by forniceal rupture. Infection and abscess formation was not established in this case.
CT scans can identify the bladder tumour and help stage the tumour, as well as identifying the complications of obstruction.
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