Presentation
Macrohematuria.
Patient Data
Several enhancing lesions in the bladder walls, bulging into the lumen. Large nonenhancing central mass - necrotic mass? large thrombus?
Several intraluminal gas bubbles, probably due previously removed urinary catheter.
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.