Urothelial bladder cancer

Case contributed by Domenico Nicoletti


Patient in the emergency room presenting with hematuria and a rising creatinine.

Patient Data

Age: 65 years
Gender: Male

Neoplastic vegetations covering the bladder inner surface, with complete obstruction of the right ureteral meatus and partial obstruction of the left. Bilateral hydroureter.


Multiple, arterial enhancing bladder lesions with signs of transmural infiltration and obstruction of bilateral ureteral meati, more so on the right. Associated bilateral hydroureter.

Annotated image

Yellow circles highlight VUJ obstruction from bladder wall thickening. 

Case Discussion

Urothelial carcinoma constitutes 90% of bladder cancer. In rare cases, bladder cancer may be an adenocarcinoma or squamous cell carcinoma.

Since this is a urothelial disease, the tumor can also be localized to the pelvis and ureter. Bladder cancer usually appears as a vegetation within the bladder, less often a red and flat lesion, visible with cystoscopy.

Urothelial cancers can be superficial - limited to the mucosa and/or the lamina propria, while others show deeper infiltration into the muscle layer.

Urothelial carcinomas can demonstrate varying degrees of aggressiveness.

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