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Urothelial carcinoma with squamous differentiation

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Macrohematuria.

Patient Data

Age: 80 years
Gender: Male

Several enhancing lesions in the bladder walls, bulging into the lumen. Large nonenhancing central mass - necrotic mass? large thrombus?

Case Discussion

Underwent TURBT (transurethral resection of bladder tumor):
The entire length of the urethra is normal; short prostate. The urinary bladder contains a large thrombus adhering strongly to the bladder mucosa, with neoplasms underneath the bladder floor, in the left wall, and around the bladder neck at 5-10 o'clock, merging with the superior and left walls. Trial of thrombus removal or fragmentation unsuccessful; finally, retrieval performed with TUR, as well as all the superficial and papillary neoplasms. On completion, urinary bladder clean, without hemorrhage.

Pathology:
Macroscopic description:
8 gray pieces of tissue with thrombi, weighing 48 g altogether.

Microscopic description:
Urothelial carcinoma high grade solid and papillary, with squamous differentiation, invasive to lamina propria, scanty fragments of smooth muscle levels seen free of tumor.

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