IS Case 387: Non-invasive low-grade papillary urothelial carcinoma
2009 URMC Imaging Sciences
Publication Date: 2010-03-08
Patient is a 22-year-old male with hematuria. No significant family or personal medical history.
IVP / excretory urogram was performed and demonstrated filling defect in the left posterolateral bladder with numerous long frond-like processes suggestive of bladder tumor. Filling defect was evident from early filling views. No filling defect of the ureters was noted; small post-void residual was grossly normal.
Transitional cell carcinoma (TCC) of the bladder is the most common cancer of the genitourinary tract, accounts for 5% of new malignant neoplasms annually in the US, and accounts for 2% of annual cancer deaths in the US. Typical presentation includes gross hematuria (as in this patient) in addition to increasing symptoms of urinary frequency, dysuria, and/or pelvic pain or pressure. Most patients are diagnosed in their 7th or 8th decade; this patient presented at an unusually young age.
IVP is the initial imaging modality of choice, with up to 70% accuracy in diagnosing bladder TCC. This patient was treated with a transurethral resection of the tumor which demonstrated a papillary mass with narrow-based stalk; surgical margins were negative and no additional imaging was performed. In patients with multicentric disease or with positive surgical margins, MRI is the imaging modality of choice to further assess the degree of tumor invasion and involvement of surrounding pelvic structures. With primary bladder tumors, only 3-5% have additional upper urinary tract tumors involving the ureter or renal pelves. On the other hand, with primary renal or ureteral tumors, up to 50% develop metachronous bladder disease within 24 - 48 months.
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