Bladder Mass Research Articles

A Novel Presentation of Bladder Mass: Self-palpation by a Patient With Cystocele

This case describes diagnosis of a T2 transitional cell carcinoma in an 89-year-old woman with known cystocele and urinary retention managed with clean intermittent self-catheterization. While self-catheterizing, the patient noted a palpable mass in her cystocele. She eventually pursued urologic evaluation of this mass, which ultimately led to her diagnosis. This is the first reported case of transitional cell carcinoma being found on self-examination by palpating a cystocele.

Progressive Cardiomyopathy in TTR Amyloidosis after Liver Transplant

Introduction Familial transthyretin (TTR) amyloidosis is a rare disorder characterized primarily by progressive neuropathy and cardiomyopathy. The source of amyloid protein is the liver, thus early liver transplantation can significantly slow disease progression. Unfortunately, for some patients without significant cardiomyopathy at the time of transplant, cardiac disease can subsequently progress due to enhanced deposition of wild-type amyloid protein. Promising new medical therapies may soon replace liver transplant as the gold standard treatment. Case report A 67 year-old male with bilateral carpal tunnel syndrome presented with hematuria and was found to have bladder masses that stained positive for amyloidosis. A work-up for systemic amyloidosis included a normal bone marrow biopsy and an echocardiogram with LVH in the absence of increased voltage on ECG. Two years later he had a cardiac arrest in the setting of sustained VT. A left heart catheterization revealed normal coronary arteries. His endomyocardial biopsy Congo red stain was positive. He was diagnosed with a previously undiscovered mutation of familial TTR amyloidosis (Glu61Gly) and five years later underwent liver transplantation. He was NYHA Class I and did well for ten years before his functional capacity gradually declined. Serial echocardiograms showed a slow progression of LV wall thickness from 1.3 to 1.7 cm and a decline in LVEF from 50% to 30%. In addition, the defibrillation threshold of his ICD progressively increased. He underwent heart transplantation due to end stage amyloid cardiomyopathy. Postoperatively he developed ulcerative esophagitis and ultimately expired due to fungal pericarditis. Discussion Although liver transplantation can slow the progression of TTR amyloidosis and is an appropriate treatment for select individuals, new alternative medical therapies may replace early transplantation. Diflunisal, an anti-inflammatory drug, stabilizes the TTR tetramer in vitro and in a randomized trial slowed progression of neuropathy in familial TTR. Combined doxycycline and tauroursodeoxycholic acid disrupt TTR amyloid fibrils and appear to slow disease progression. Tafamadis, a small molecule that inhibits the dissociation of TTR tetramers has been shown in phase 2 and 3 trials to slow neuropathy progression and decrease mortality and heart failure hospitalizations. Patisiran is a small interfering RNA that blocks TTR synthesis and has demonstrated stabilization of neuropathy. Inotersen is an antisense oligonucleotide that has also shown promise in familial TTR patients with polyneuropathy. Most recently, an investigational monoclonal antibody has been designed to target and remove amyloid deposits. Conclusion Familial TTR amyloidosis is characterized by progressive neuropathy and cardiomyopathy for which patients may undergo liver transplant, though cardiac disease can subsequently progress. Promising new medical therapies may soon replace liver transplant as the gold standard.

Primary small-cell neuroendocrine carcinoma of the urinary bladder: A rare case and a review of the literature.

Primary small-cell neuroendocrine carcinoma (SCNEC) of the urinary bladder is a rare tumor characterized by poor differentiation and high aggressiveness. Only ~150 cases have been reported in the literature to date. We herein present a case of an 87-year-old man who presented with hematuria and was found to have an ill-defined mass in the urinary bladder on computed tomography and cystoscopic examination. On pathological examination following tumor biopsy, the mucosa of the bladder wall was found to be extensively infiltrated by neuroendocrine carcinoma, positive for CD56 and synaptophysin and negative for epithelial membrane antigen, consistent with SCNEC of the urinary bladder. The patient refused further surgical treatment and succumbed to the disease 2 months after the diagnosis. In the present study, this rare case of primary SCNEC of the urinary bladder is presented, along with a discussion on the clinical presentation, immunohistochemical and cytomorphological characteristics, management, biological behavior and prognosis of this disease.

Endocrine disruptor bisphenol A is implicated in urinary voiding dysfunction in male mice.

Estrogens, acting synergistically with androgens, are known from animal experiments to be important in lower urinary tract symptoms (LUTS) and benign prostate enlargement. Human exposure to environmental estrogens occurs throughout the life span, but the urologic health risks in men are largely unknown. Bisphenol A (BPA) is an endocrine disruptor implicated in male urogenital malformations. Given the role of estrogens in male LUTS, we studied the effects of BPA administered in combination with testosterone (T) on the urinary voiding behavior of adult male mice. Adult male mice underwent subcutaneous implantation with slow-release pellets of 25 mg BPA or 2.5 mg estradiol-17β (E2), plus 25 mg T, and were compared with untreated (UNT) mice that underwent sham surgery. We studied urinary voiding behavior noninvasively for 1 mo before treatment and for 4 mo after treatment. After euthanasia, we evaluated bladder volume and mass. Mice treated with T+BPA had increased bladder volume ( P < 0.05) and mass ( P < 0.01) compared with UNT mice. After 4 mo of treatment with T+BPA, three of five mice developed voiding dysfunction in the form of droplet voiding or an intermediate pattern of voiding different from both UNT and T+E2-treated mice. Treatment of male mice with BPA or estradiol induces voiding dysfunction that manifests at later time points, implicating the endocrine disruptor, BPA, as a contributor to male LUTS.

West Virginia Resident is First American to Receive Dicycloplatin Chemotherapy: A WVU Urologic Oncology Case Report

A 65-year-old Caucasian male presented with increasing hematuria over four months in 2016. Work up and scans revealed a 1.5 cm bladder mass, with a subsequent pathologic diagnosis of non-invasive high-grade papillary urothelial carcinoma. The patient declined BCG Immunotherapy and traveled to China soon after diagnosis and transurethral resection for Dicycloplatin (DCP) chemotherapy. DCP is approved by the Chinese FDA but only available at present in military hospitals. It is similar in molecular structure to platinum-based chemotherapy drugs used in the West, its side effects reported to be more tolerable. The patient received 8 weeks of IV DCP chemotherapy – he only experienced mild nausea, myralgia, a relative leukopenia and thrombocytopenia (though within normal limits) and, importantly, no alopecia – then returned to WV for quarterly surveillance. No recurrence of tumor has been observed to date; the most recent cystoscopy was on April 24, 2018, 22 months after diagnosis and resection.

What is your diagnosis? Bladder mass in a mare

What is your diagnosis? Bladder mass in a mare

Abstract 3629: Repeated abscopal effect with radiation and anti-PD-1 blockade in MMR deficient endometrial cancer

Abstract The combination of radiation therapy and immune checkpoint inhibitors has raised interest as possibly having synergistic antitumor effects. Radiation can induce both a local response as well as a systemic one that stimulates immune cells, which then can be further potentiated by immunotherapy. This abscopal effect has been validated in preclinical studies and is currently being studied in clinical trials, though it has yet to be reported in gynecologic cancers. A 64-year-old woman initially presented with vaginal bleeding and was subsequently diagnosed with stage IIIC endometrial adenocarcinoma with pelvic and para-aortic lymphadenopathy. She underwent surgical resection with adjuvant carboplatin and paclitaxel. Follow-up CT scans showed progression of disease, and over the next 18 months, the patient was sequentially treated with doxorubicin, topotecan, melphalan, docetaxel, and capecitabine. Analysis of a tumor biopsy demonstrated an MMR deficient phenotype with absent MLH1 and PMS2. Based on the recently-published data on the efficacy of PD-1 inhibitors in MMR deficient solid tumors, the patient was started on nivolumab. Meanwhile, she was given palliative radiation therapy to the following areas: painful cutaneous metastases on her left thigh; an L3 spinal metastasis; lymph nodes in the retroperitoneum, external iliacs, and left inguinal chain; and a symptomatic bladder mass. After radiation, the patient exhibited a strong partial response not only in the targeted lesions but also throughout her tumor burden, consistent with an abscopal effect. This response was sustained over many months and repeatable with each radiation session. The synergistic use of radiation therapy and immune checkpoint blockade may thus represent a powerful treatment modality in endometrial cancer and warrants further clinical investigation. Citation Format: Michael S. Oh, Young Chae. Repeated abscopal effect with radiation and anti-PD-1 blockade in MMR deficient endometrial cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3629.

A Rare Location and Presentation of Pheochromocytoma.

Background: Pheochromocytomas typically are diagnosed in the adrenal gland and from the sympathetic nervous system. Bladder pheochromocytoma is a rare location for this tumor.Case Presentation: We describe a 67-year-old Afro Caribbean woman referred to our hospital for an asymptomatic bladder tumor. Preliminary transurethral resection revealed bladder pheochromocytoma. After a comprehensive endocrine evaluation, we performed a robot-assisted laparoscopic partial cystectomy with ureteral reimplantation.Conclusion: We present a rare case of bladder pheochromocytoma treated effectively with minimally invasive techniques. When confronted with a solid bladder mass, apart from the more common urothelial malignancies, a differential diagnosis of bladder pheochromocytoma should also be considered.

Vaginal Myomectomy to Resolve Bladder Outlet Obstruction 50 Years After Hysterectomy.

Leiomyomas can develop after hysterectomy and, when located in the bladder, can result in voiding dysfunction and incontinence. Fifty years after a hysterectomy, a 77-year-old woman presented with a 1-year history of urinary retention requiring self-catheterization and bothersome urinary incontinence. Multiple imaging modalities demonstrated a well-circumscribed 2-cm mass abutting the bladder beneath the trigone. After ureteral stent placement, we excised the nonpalpable mass using ultrasound guidance. We identified a 1.5-cm incidental cystomy and repaired it in layers. After the repair, we placed a suprapubic catheter. Pathologic examination of the mass revealed a leiomyoma. Postoperatively, we confirmed the integrity of the bladder, removed the ureteral stents, and reviewed postvoid residuals, which were minimal before removing the suprapubic catheter. Six weeks after her operation, the patient voided spontaneously with significant improvement of her urinary incontinence. Vaginal resection with ureteral stenting represents a safe surgical approach for resection of a symptomatic, benign bladder mass.

First Trimester Diagnosis of Cloacal Exstrophy: A Discordant Anomaly in Monochorionic Monoamniotic (MCMA) Twins—Case Report

AbstractCloacal exstrophy is a rare anomaly, with a severe disruption of the urogenital tract resulting in a central mass of exstrophic bowel field flanked by two hemibladders. The reported case highlights the diagnosis of this discordant anomaly in monochorionic monoanmniotic twins as early as 12 weeks. It underscores the major ultrasound criteria like non visualisation of fetal bladder and infra-umbilical protruberant heterogenous mass which have an important role in early prenatal diagnosis of the anomaly.

Pelvic dystopia of right rudimentary multicystic dysplastic kidney as a rare cause of bedwetting in a patient with a\xa0single pelvic ectopic left kidney, and agenesis of the\xa0uterus and vagina (Mayer-Rokitansky-K\xfcster-Hauser syndrome): a case report

BackgroundPelvic dystopia of rudimentary multicystic dysplastic kidney as a rare cause of bedwetting in children.Case presentationWe report the case of a 14-year-old Kazakh girl who presented with difficulty in starting the stream of urine and intermittent interruption of the urinary stream while voiding as well as bedwetting, caused by a rare congenital disease (pelvic dystopia of rudimentary multicystic dysplastic kidney). The diagnostic workup, differential diagnosis, and management, and a review of the literature are presented. Persistent since she was 2 years old, bedwetting was stressful for both the parents and child. Initially detected radiologically and endoscopically, a bladder mass was thought suspicious for ureterocele, papilloma, or mixed tumor of the urinary bladder, but surprisingly, turned out to be a pelvic dystopia of the rudimentary multicystic dysplastic kidney. Transvesical excision of this mass was performed.ConclusionsThe purpose of this case report is to draw attention to the fact that a persistent case of bedwetting which does not respond to conventional therapy should be subject to further examinations to exclude surgical causes of the disease.

Urothelial carcinoma in children: A case series

To report a series of 5 patients with urothelial bladder cancer (UBC) three of them with a history of exposure to amines and only two with gross hematuria. After obtaining ethical and legal authorization, we performed a restrospective monocentric study. We collected information of patients with UBC over a period of 10 years. We recorded: age, sex, reason for presentation, familial history and risk factors, preoperative assessment, surgical details, histological type and grade, follow-up. 2 children came to our attention for hematuria and 3 for incidental bladder mass finding, at a median age of 11.8 years. We performed microscopically complete transurethral resection of the tumor (TURB). Median tumor size was 1.8cm. No further therapy was required. All cancers belonged to NMIBC (Non-muscle-invasive Bladder Cancer) considering the 2004 WHO classification: 2 urothelial papillomas, 2 papillary tumors with low grade malignancy (PUN-LPM) and 1 papillary urothelial carcinoma of low histological grade (LG-PUC Ta, N0, M0). There was not any complications and no relapse occurred during follow-up (median 30 months). In this study, UBCs presenting at a young age were low-grade and have not recurred in follow-up. This confirms the results of other series reported in Literature. Therefore there might be the space to perform a follow-up dedicated to children.

Quantitative evaluation of canine urinary bladder transitional cell carcinoma using contrast-enhanced ultrasonography

BackgroundIn veterinary medicine, contrast-enhanced ultrasonography allowed the accurate quantification of liver, splenic and kidney vascularization in healthy dogs and the differentiation between malignant and benign hepatic, renal, and splenic nodules in dogs and cats based on perfusion patterns. The utility of contrast-enhanced ultrasonography in other applications is still under study.The aim of this study was to develop diagnostic criteria by contrast-enhanced ultrasonography in 8 client-owned adult dogs affected by urinary bladder transitional cell carcinoma with definitive diagnosis made by cytopathologic evaluation after suction biopsy. The contrast enhancement pattern and the quantification of blood flow parameters of this tumor were reported.ResultsExaminations with B-mode, Doppler ultrasonography and contrast-enhanced ultrasonography were performed in all not sedated dogs. Assessments of bladder masses and bladder wall infiltration were performed. Each dog received 2 bolus injections of sulfur hexafluoride during the contrast-enhanced ultrasonography. Quantitative analysis of the contrast-enhanced ultrasonography images were performed. For each dog, one region of interest was manually drawn around the entire tumor. Software analysis of contrast-enhanced time-intensity curves was used to identify peak enhancement, time to peak enhancement, regional blood volume, regional blood flow, and mean transit time.Contrast-enhanced ultrasonography showed an avid enhancement of the tumour tissue, with a heterogeneous or homogeneous pattern. The exam also showed the loss of planes between the lesion and the muscular layer. The presence of vascularized tissue through the bladder wall confirms the infiltrative feature of the tumour. Post-processing quantitative analysis showed a time-intensity curve with a rapid wash-in, a low level of signal intensity and a slow wash-out.ConclusionsContrast-enhanced ultrasonography provided useful clinical information and defined a vascular enhancement patterns and calculated parameters associated with TCC. It may be a useful, noninvasive and reproducible tool for detecting these tumors in dogs.

DIAGNOSIS AND SURGICAL TREATMENT OF A TRANSITIONAL CELL CARCINOMA IN THE BLADDER APEX OF A PET RABBIT (ORYCTOLAGUS CUNICULUS)

A 6-year-old, 1.9-kg female spayed lop-eared European rabbit (Oryctolagus cuniculus) was evaluated for acute hematuria and inappropriate urination and defecation of less than 12-hours duration. Abdominal ultrasonography revealed a suspected bladder mass. Ultrasound-guided cystocentesis was performed and the results of the urinalysis were unremarkable. An abdominal exploratory surgery revealed a nodular cystic mass at the cranial ventral apex of the bladder wall which measured 0.5cm × 0.5cm. Based on histopathologic evaluation, excision of the neoplasm was complete and the mass was diagnosed as transitional cell carcinoma of the bladder. This case suggests that urinary bladder transitional cell carcinoma should be considered in pet rabbits presenting with similar clinical signs.

Diagnostic performance of diffusion-weighted MR imaging at 3.0T in predicting muscle invasion in urinary bladder cancer: utility of evaluating the morphology of the reactive tumor stalk.

To evaluate the diagnostic performance of stalk morphology on diffusion-weighted imaging (DWI) in comparison with conventional MRI in predicting muscle invasion in urinary bladder cancer. The study was prospective and approved by the institutional ethics committee. A written informed consent was obtained from all the patients. The study included 56 patients who presented with bladder mass between January 2014 and November 2015. After excluding 16 patients, 40 patients with 92 tumors were assessed. All the 40 patients underwent MRI at 3.0 Tesla (Achieva, Philips) inclusive of DWI (b0, 500, 1000 and 1500). Two radiologists evaluated the images independently, and disparities were resolved through consensus. For predicting muscle invasion on T2-weighted images, tumor morphology (papillary versus non-papillary), distensibility of the underlying bladder wall, and perivesical fat infiltration were evaluated. On DWI, the criterion used in a previous study (Takeuchi et al.) was used along with tumor stalk morphology. Findings were compared with histopathology using Pearson's χ2 test, and diagnostic performance indices were calculated. All the evaluated features were present with significantly higher frequency in muscle-invasive tumors (p<0.001). The finding of absent or distorted stalk on DWI had the highest sensitivity (87.5%) and specificity (97.6%). Conventional imaging features of non-papillary stalk morphology, restricted distension of underlying bladder wall, perivesical fat infiltration, as well as the previous DWI criterion were less sensitive (56.3%, 68.8%, 56.3% and 56.3%, respectively) in predicting muscle invasion. Assessment of the morphology of the reactive tumor stalk on DWI has better diagnostic performance in predicting muscle invasion than conventional MRI.

Multimodality management of incidentally detected gall bladder cancer: long term results from a tertiary care cancer centre.

Gall bladder cancer (GBC) is the most common biliary tract malignancy in India. GBC present either with incidental diagnosis after simple cholecystectomy (SC) or with a primary gall bladder mass. Incidentally detected gall bladder cancer (ICGB) has traditionally been thought to be a relatively early stage disease but there are controversies associated with various aspects of its management. In this article we describe our experience with multimodality management of ICGB. A retrospective analysis of incidentally detected GBC patients was performed to analyze the profile of presentation and treatment outcome. After initial radiological evaluation for operability, all the patients underwent surgical exploration. If found resectable, revision surgery including 2 cm wedge resection of liver and lymphadenectomy was done followed by concurrent chemo-radiation for tumors T2 and above stages. A total of 54 patients with incidentally detected GBC with a male to female ratio of 1:3 and mean age of 47.5 years were included in the study. Thirty-four (63%) patients underwent curative resection followed by adjuvant chemoradiotherapy. The remaining 20 patients had metastatic/unresectable disease. The 5 years disease free and overall survival (OS) for patients receiving curative treatment was 64% and 72% respectively. On univariate analysis, presence of residual disease in the gallbladder fossa and liver were significant risk factors for disease recurrence. Depth of invasion, adjuvant treatment received and stage were significant prognostic factors for OS. Incidentally detected GBC is increasing in incidence. A multi-modality approach with revision surgery and adjuvant chemo-radiation treatment may yield better outcome. Presence of residual disease is a poor prognostic factor. Optimal evaluation before SC and early referral to specialty center is therefore important in patients with suspicion of gallbladder malignancy because first chance is probably the best chance.

Bladder Leiomyoma: A Rare Differential and a Potential Pitfall in the Evaluation for a Bladder Mass in 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.

18F-Fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG PET/CT) has shown an increasing role in the evaluation of urinary bladder cancer, though benign pathological processes of the urinary bladder can also result in increased FDG uptake. Leiomyomas of urinary bladder are benign mesenchymal neoplasms and a very rare bladder tumor comprising <0.5% of all bladder tumors. Here, we present the low-grade 18FDG uptake in urinary bladder leiomyoma on PET/CT done for the clinical suspicion of bladder cancer, which can be a rare differential for bladder carcinoma.

Diffusion weighted magnetic resonance imaging in bladder cancer, is it time to replace biopsy?

IntroductionTo assess if the apparent diffusion coefficient (ADC) value of magnetic resonance imaging (MRI) can discriminate between the cell type, histological grade and improve staging of urinary bladder cancer (BC).Material and methods102 patients with urinary bladder masses underwent MRI using a 1.5 T machine. T2 weighted and diffusion weighted imaging (DWI) using b values of 0, 150, 500 and 1000 s/mm2 were done. The ADC values of bladder masses were measured. These values were correlated with the histopathologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of T2WI, DWI and T2WI plus DWI for detecting bladder lesions were evaluated.RESULTSThe cut-off ADC value for diagnosing malignant bladder wall pathologies was ≤1 x 10-3 mm2/s with 94.5% sensitivity and 87.5% specificity. The mean ADC value of different malignant cell types was statistically insignificant. A significant difference in ADC values was found between G1 and G3 (P = 0.000), G2 and G3 (P = 0.045) but not between G1 and G2 (p = 0.066). Staging accuracy for differentiation between invasive and non-invasive lesions was nearly the same for all MRI data sets. For differentiation between organ confined (pT1–pT2) and non-organ confined lesions (pT3–pT4), staging accuracy was better in T2WI plus DWI (83%) as compared to DWI alone (77%) or T2WI alone (75%).ConclusionsAdding DWI and the ADC value to T2WI improve the accuracy of MRI in BC detection and staging. However, at this time point, MRI cannot replace transurethral resection (TUR) biopsy or distinguish sharply between all different histologic grades and cell types.

Diagnostic utility of touch imprint cytology in the evaluation of intraabdominal tumors

Objectives: Touch imprint cytology (TIC) of biopsy specimen can be utilized for a rapid on-site evaluation of tumors. Its usefulness for intraoperative diagnosis is well known. We evaluated the advantages and limitations of TIC of trucut biopsies of intraabdominal tumors. Materials and Methods: TIC was obtained in 42 consecutive cases of intraabdominal masses. The sensitivity, specificity, and diagnostic accuracy of TIC were evaluated by comparing it with the final biopsy diagnosis. Results: The study included retroperitoneal tumors (13 cases, 30.95%), liver mass (11 cases, 26.19%), gall bladder mass (4 cases, 9.53%), pelvic mass (3 cases, 7.14%), iliac bone mass (2 cases, 4.76%), mesenteric nodule (4 cases, 9.53%), kidney mass (3 cases, 7.14%), and 1 case (2.38%) each of epigastric mass and loin mass. Thirty-two (76.19%) cases were diagnosed as malignant and 10 (23.81%) cases were diagnosed as benign/negative on TIC. The overall sensitivity was 87.88%, the specificity was 77.78%, the positive predictive value was 93.55%, and the negative predictive value was 63.60%. The accuracy of the test was 85.71%.Conclusions: TIC is a simple and cost-effective method that aids in the diagnostic evaluation of tumors. It is fairly accurate with high positive predictive value and hence can be used as an adjunct to the biopsy diagnosis.

Cystoscopic findings of canine bladder masses

Cystoscopic findings of canine bladder masses