Bladder Mass Research Articles

Single center evaluation of sensitivity and specificity of CellDetect assay in early bladder cancer patients

Until recently, the main diagnostic methods for bladder cancer (BC) are still voided urine cytology and cystoscopy, and many drawbacks persist. In this retrospective study, we evaluated the sensitivity and specificity of the CellDetect assay in the detection of BC with comparison to standard diagnostic methods. Between August 2020 and July 2022, B-ultrasonography or computed tomography (CT) scan was performed for patients with hematuria or irritative voiding symptoms. If no bladder mass was detected, the patient was excluded. A total of 148 patients with bladder mass formed the final study cohort. The patients’ urine samples were measured with CellDetect assay, followed by cystoscopy or diagnostic transurethral resection of bladder tumor. The patients were divided into two groups based on previous history of BC: group P and group R. The analysis included descriptive statistics and percentages. Finally, 115 cases had a positive CellDetect result, with 68 cases in group P and 47 in group R, respectively. And 134 cases revealed malignant tumor pathologically. The overall sensitivity and specificity for all patients were 82.1% and 64.2%, respectively. Concerning the subgroups, the respective sensitivity and specificity were: in group P- 81.0% and 50.0%; and in group R- 85.2% and 83.3%, respectively. In conclusion, CellDetect assay demonstrated significant performance for diagnosis of BC: it can identify BC patients at early stage with significant diagnostic performance and good reliability. This assay might develop novel methods and ideas for future clinical practice.

Solitary fibrous tumor of the bladder: A rare cause of bladder outlet obstruction in an adult male

IntroductionSolitary fibrous bladder tumors are extremely uncommon, with only a few cases reported. These fibroblastic mesenchymal neoplasms are typically benign, indolent, and slow growing.Case presentationA 44‐year‐old male patient with obstructive uropathy was referred to our unit for workup. Ultrasonography and MRI of the pelvis showed a large, well‐circumscribed bladder mass, also visualized cystoscopically. This mass was excised en bloc using the Pfannenstiel approach. Histopathological and immunohistochemical analyses revealed a solitary fibrous tumor.ConclusionThe management of SFTs can be challenging due to the lack of established guidelines. Hence, we offered our patient long‐term follow‐up. Twelve months postoperatively, no recurrence or metastases were found on the follow‐up imaging.

Migration of intrauterine device to the bladder with associated vesicolithiasis: a case report

Migration of intrauterine device (IUD) is a frequent complication of IUD insertion. Most IUD migration is only displaced in the uterine cavity, but in rare cases IUD could migrate to other pelvic organs, such as the pelvic cavity, rectum, or the bladder. We reported a case of 80-years old female with one month history of hematuria and pain, which further examination shows vesicolithiasis and bladder mass. During lithotripsy, intrauterine device was visualized inside the stone, which the patient admitted had been inserted 40 years ago. This case is remarkable, as it is rare to have a longstanding IUD placement with intravesical migration, vesicolithiasis, and bladder malignancy.

Cardiac metastasis from carcinoma gall bladder - a rare case detected on autopsy

Metastasis to the heart is uncommon compared to other organs, posing notable diagnostic challenges. Incidence in autopsy studies typically ranges between 0.7% and 3.5%. Lung, breast, and hematologic cancers are the main sources of such metastases, leading to varied clinical presentations and severe complications. Postmortem viscera from a 47 year old male with a suspected history of jaundice. Only limited information was available. Gross examination showed a solid mass in the gall bladder with areas of hemorrhage and necrosis, while no other abnormalities were observed in other viscera received. Brain examination showed congested blood vessels, while heart sections exhibited atypical cell deposits in the pericardium and myocardium. Coronary arteries displayed pathological thickening. Lung and liver sections also displayed similar metastatic atypical cell deposits, infiltrating tissue and causing necrosis. Gall bladder examination revealed irregular glandular formations lined with polygonal tumor cells positive for cytokeratin. The final diagnosis based on histomorphological features and immunohistochemistry confirmed gall bladder adenocarcinoma metastasising to the heart, liver and lungs.

Abstract C161: Rare Invasive Plasmacytoid Urothelial Carcinoma Presenting as Post-Renal Acute Kidney Injury: A Case Report

Abstract Purpose: Plasmacytoid urothelial carcinoma stands out as a rare and highly aggressive histological subtype within the spectrum of bladder carcinomas, constituting only 1-3% of all variants. Summary: In this case report, we present the case of a 72-year-old patient who initially presented with significant obstructive uropathy and hydronephrosis secondary to invasive plasmacytoid urothelial carcinoma. Admission labs were concerning for a hemoglobin level of 3.8, requiring 3 units of red blood cells for correction, potassium level of 8.8, for which urgent hemodialysis was given, and a lactate level of 5.4. The patient subsequently developed delayed hematuria one month later. Follow-up CT imaging revealed an alarming increase in the size of the bladder mass, underscoring the rapid progression of the malignancy. Discussion: The aggressive nature of this malignant neoplasm can be attributed to its diffuse pattern of infiltration and high risk of residual disease following radical surgery. Clinical manifestations often include abdominal pain, but lack early-onset hematuria and other urinary symptoms typically seen with other subtypes, leading to diagnostic delays and late-stage identification. Conclusion: This case report highlights the uncommon clinical presentation of plasmacytoid urothelial carcinoma (PUC), manifesting as obstructive nephropathy. The inherent aggressiveness associated with PUC poses a challenge in treatment due to the advanced stage of the malignancy at the time of diagnosis. The scarcity of guidelines for the management of PUC underscores the need for extensive future studies to bridge this gap. Citation Format: Andressa Uzeda, Toral Shastri, Kamilia Moalem, Kendra Van Kirk. Rare Invasive Plasmacytoid Urothelial Carcinoma Presenting as Post-Renal Acute Kidney Injury: A Case Report [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C161.

A RARE CASE OF COEXISTING BLADDER SMALL CELL NEUROENDOCRINE CARCINOMA AND PROSTATE ADENOCARCINOMA: CASE REPORT AND LITERATURE REVIEW

Objective: We present a case of synchronous malignancies of rare bladder small cell neuroendocrine carcinoma (SCNC) and prostate adenocarcinoma and provide literature review of bladder SCNC. Case(s) presentation: A 72-year-old male smoker presented with 3 months history of gross hematuria. Ultrasonography showed a large hypoechoic mass in the right bladder. TURBT was performed and histopathology of the TURBT specimen showed a high-grade papillary urothelial carcinoma. Abdominal contrast-enhanced computed tomography (CECT) demonstrated an isodense heterogenous undefined mass, with irregular border at right anterolateral side of bladder wall. Radical cystoprostatectomy, bilateral radical lymph node dissection and bilateral ureterocutaneostomy was performed. Histopathology and immunohistochemical examination after radical cystoprostatectomy revealed bladder small cell neuroendocrine carcinoma coexisting with prostate adenocarcinoma (Gleason score 3+3=6, group 1). The patient eventually succumbed to disease after having symptomatic disease progression and metastatic disease five months after the surgery. Discussion: Bladder SCNC is a rare malignancy with an incidence of 1–9/1,000,000 reported. This tumor has an aggressive clinical course with high incidence of metastasis, and it tends to confer dismal prognosis. No specific clinical symptom exists. Histopathological recognition and immunohistochemistry is required to differentiate this rare entity. Conclusion: Clinicians and pathologists should be alert to the possibility of bladder SCNC despite extremely scarce incidence. Keywords: Bladder cancer, small cell neuroendocrine carcinoma, synchronous malignancy, case report.

Urachus carcinoma initially presenting only as a liver metastasis, a diagnostic and therapeutic challenge: First case in literature

Introduction: Urachal carcinomas are uncommon malignant neoplasms comprising only 0.01% of all adult cancers. Most patients were aged from 58 to 64 years at diagnosis with 60 years being the median. It usually metastasizes to the lungs (22%), bones (22%), and liver (16%). Presentation: We report a case of a 71-year-old female patient initially presented with two large liver masses and a small nodule on the anterior side of the bladder. The symptoms were non-specific with abdominal discomfort. The final diagnosis of Urachal Adenocarcinoma was finalized with a biopsy of the bladder mass. The patient initially received six doses of FOLFOX6 without improvement and then Gem-Carbo, showing improvement after six doses. Finally, the patient received two doses of FOLFIRI-B with no response and kept deteriorating and died after 19 months of treatment. Discussion: About 90% of patients are symptomatic and hematuria is the most typical presenting symptom at diagnosis. The low incidence and the histopathologic similarities to adenocarcinoma from various sources pose a difficulty in recognizing the tumor. Our study presents the only case of a urachal carcinoma first manifesting with abdominal mass resulting from liver metastasis with no prior symptoms of urological origins. Also, our study presents the first attempt of using FLOFIRI-B to treat metastatic UraC. Conclusion: This case highlights the necessity for clinicopathological correlation to make the correct diagnosis and the challenges in the treatment which urges the need for further research to identify more effective treatment strategies for this rare cancer.

Eosinophilic cystitis-an obscure case of obstructive uropathy in infancy.

We report on an infant with features of intermittent obstructive uropathy, acute kidney injury, hypertension and type 4 renal tubular acidosis (RTA) despite urethral catheterisation and fluid resuscitation. Radiological findings showed upper tract dilatation, likely bilateral vesicoureteric junction obstruction and bladder base thickening which was concerning for possible malignancy. Renal biopsy demonstrated eosinophilic infiltrate, suggestive of kidney involvement. Bladder biopsy was diagnostic for eosinophilic cystitis (EC) showing mature degranulating eosinophils. EC is a rare, easily treatable and important differential of bladder mass in children which may present with an atypical obstructive uropathy. This report adds to the limited literature of this condition within the paediatric population. EC should be considered early in children presenting with eosinophilia, urinary tract obstruction and kidney dysfunction, with uncertain aetiology. This case also highlights the need for detailed imaging, including visualisation of the bladder base, in cases of likely obstructive uropathy.

Computed Tomography Evaluation of Gall Bladder Mass with Histopathological Correlation

Background: In extrahepatic biliary carcinoma patients, unresectable disease is frequently discovered during exploration despite thorough preoperative assessment, leading to unnecessary laparotomy. Gallbladder carcinoma ranks fifth among gastrointestinal malignancies, following colorectal, pancreatic, gastric, and esophageal carcinomas. Aim of the study: The aim of the study was to establish the diagnostic usefulness of computed tomography (CT) in the diagnosis of gallbladder mass. Methods: This case-control study was conducted at the Department of Radiology and Imaging, Rajshahi Medical College Hospital, Rajshahi, Bangladesh from March 2018 to August 2018. The study included 65 patients diagnosed with a gallbladder mass, selected through purposive sampling. SPSS version 23.0 was utilized for data analysis. Results: CT scans accurately predicted various features of gallbladder mass, showing high sensitivity, specificity, and accuracy, with positive and negative predictive values of ≥95% for adenocarcinoma, squamous carcinoma, cholecystitis, metastases, GB polyp, and adenoma. Chronic cholecystitis sensitivity was over 83%. Overall, CT diagnosis performed at least 88.9% across all features. The histopathological assessment also detected nearly similar features of gallbladder mass. Conclusion: Computed tomography (CT) serves as a valuable diagnostic tool for distinguishing gallbladder neoplasms preoperatively. It is worth noting that CT scans aid in the rational management approach for patients with gallbladder neoplasms.

Inflammatory myofibroblastic tumor of urinary bladder in young male: A case report and literature review

The objective of this study is to present a rare case of inflammatory myofibroblastic tumor (IMT) of the urinary bladder in young male, detailing its clinical presentation, diagnostic approach, treatment strategy, and outcome. Additionally, the objective includes conducting a literature review to provide insights into the characteristics, management, and prognosis of this uncommon tumor entity.A 20-year-old male presenting with dysuria and dribbling of urine underwent diagnostic workup including imaging studies, cystoscopy. On cystoscopy there was a presence of 5x4 cm sized pedunculated mass in the urinary bladder. Partial cystectomy is done and specimen is examined for histopathology. Histopathological examination and Immunohistochemistry study of the tumor specimen was performed to confirm the diagnosis of inflammatory myofibroblastic tumor. A thorough literature review was conducted to gather relevant studies on IMT of the urinary bladder, focusing on clinical presentations, diagnostic modalities, treatment approaches, and outcomes. Diagnostic evaluation revealed a mass lesion in the urinary bladder, and histopathological examination following partial cystectomy confirmed the diagnosis of inflammatory myofibroblastic tumor. The patient underwent surgical excision of the tumor followed by adjuvant therapy. Regular follow-up examinations showed no evidence of tumor recurrence. The literature review identified a limited number of reported cases of IMT of the urinary bladder in young male, emphasizing its rarity and diverse clinical presentations. Various diagnostic modalities and treatment options, including surgery, chemotherapy, and targeted therapy, were discussed in the reviewed literature. Inflammatory myofibroblastic tumor of the urinary bladder is a rare neoplasm at younger age that can present with nonspecific symptoms, making its diagnosis challenging. However, timely recognition and appropriate management, including surgical resection and adjuvant therapy, can lead to favorable outcomes with low recurrence rates. This case report highlights the importance of considering IMT in the differential diagnosis of bladder masses in young patient and underscores the need for further research to better understand the pathogenesis and optimal treatment strategies for this rare tumor entity.

Laparoscopic Enucleation of an Extravesical Bladder Leiomyoma: A Case Report

BackgroundThe management of leiomyomas, the most common benign mesenchymal tumours, remains highly debated. This case report presents the first laparoscopic enucleation of an extravesical bladder leiomyoma in Indonesia.Case presentationA 48-year-old man presented with a lower abdominal mass. An abdominopelvic computed tomography scan showed a solid tumour mass in the right anterolateral wall of the bladder. To excise the mass, it was planned for the patient to undergo laparoscopic enucleation. The mass was removed intact, and a frozen section was taken to determine the malignancy profile. Histopathological examinations, followed by immunohistochemical examinations, confirmed the diagnosis of leiomyoma.ConclusionsLaparoscopic enucleation is a promising option for managing bladder masses. It is a minimally invasive procedure with optimal results for preserving bladder function. Prior to the surgery, imaging studies and cystoscopy examination are mandatory.

Hematuria Due to Possible Histoplasma-Associated Urinary Bladder Pseudotumor With Negative Serologic and Urine Antigen Testing

Abstract Histoplasma capsulatum is a ubiquitous dimorphic fungus causing multiple infectious syndromes, ranging from subclinical to severe disseminated disease. We present an unusual case of hematuria due to pedunculated urinary bladder mass in an immunocompetent host. Although the gold standard for diagnosis of histoplasmosis is through demonstration of characteristic yeast forms on histopathologic examination of infected tissue, or observation of typical mycelial growth in culture of clinical specimens, investigational multiplex polymerase chain reaction of formalinized tissue was helpful in this case due to conflicting serologic testing, equivocal morphologic findings on histopathologic examination and, surprisingly, a negative urine Histoplasma antigen despite anatomically proximal location within the urinary bladder. Although antigen immunoassay and serology are commonly used proxy diagnostics in Histoplasma-associated disease, varying performance characteristics in certain disease states, such as cases of locally proliferative infection mimicking neoplastic growth similar to this report, may lead to elusive diagnosis.

POU2F3-positive small cell carcinoma of the bladder: A clinicopathologic analysis of 4 cases and literature review

POU class 2 homeobox 3 (POU2F3)-positive small cell bladder carcinoma (SCBC) is an extremely rare entity, and its clinicopathologic features have not been fully described. Here, we investigated the clinicopathologic features of 4 cases of POU2F3-positive small cell bladder carcinoma (SCBC) and reviewed the literature. We collected 12 cases of SCBC from our departmental archives and detected the expression of POU2F3 by immunohistochemical (IHC) staining. Selected cases with or without POU2F3 expression were subjected to gene expression analysis between two different groups using DESeq2 software. We identified 4 POU2F3-positive SCBC patients, 2 males and 2 females, with a mean age of 77 years. Three patients had hematuria, and 1 patient had dysuria. Radiologic findings showed a bladder mass. Pathologic diagnosis showed that 3 cases were pure SCBC and 1 was mixed urothelial cancer (UC). Histopathologically, four POU2F3-positive SCBC tumors were composed of small round cells with sparse cytoplasm, the nuclei were salt-and-pepper-like or finely granular. Tumor cells showed characteristic cytoplasmic staining with punctate positive signals for cytokeratin. Syn and CD56 were diffusely positive in all the 4 patients. CgA was positive in only one patient. POU2F3-positive SCBC showed higher expression levels of POU2F3, HMGA2 and PLCG2 genes by RNA-Seq. Our data showed the specific clinicopathologic features of 4 rare POU2F3-positive SCBC cases, and the distinct molecular feature was observed between POU2F3-positive and negative SCBC in the limited number of cases.

Urinary bladder involvement in IgG4-related disease: A case-based review.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-driven fibroinflammatory disease that presents as tumefactive lesions that not only commonly affects the pancreas, lacrimal and salivary glands, lung, liver and kidney but can also affect any organs. However, involvement of the urinary bladder in IgG4-RD is rarely reported. We describe a case of IgG4-RD involving the urinary bladder mimicking carcinoma and review the published literature-a 39-year-old male presented with complaints of dysuria, urgency and hesitancy. Ultrasound revealed a hyperechoic lesion protruding from the anterior of the urinary bladder wall with partial obstruction to bladder outflow, likely to be a pedunculated bladder mass with high suspicion for malignancy. A contrast-enhanced computed tomography abdomen showed a large irregular lobulated heterogeneously enhancing lesion involving the anteroinferior wall of the urinary bladder extending from mid-body up to the neck region with significant perivesical fat stranding and multiple ill-defined perivesical deposits along with hypodense soft tissue lesion in the perigastric region at the level of the body of the stomach. CT-guided perigastric and ultrasound-guided biopsy from the urinary bladder mass confirmed the diagnosis of IgG4-RD. The patient was treated with glucocorticoids. He is doing well after a 1-year follow-up without recurrence, and a repeat ultrasound showed a significant reduction in the size of the urinary bladder mass. The diagnosis of IgG4-RD should be considered in the differential diagnosis of a urinary bladder mass. High index of suspicion and prompt initiation of therapy are required to minimise residual damage and the need for surgical intervention.

Comparison of narrow band imaging versus white light imaging in detecting non muscle invasive bladder cancer.

In the present study, we compared Narrow Band Imaging (NBI) and White Light Cystoscopy (WLC) in Non-muscle invasive bladder cancer (NMIBC) for detection and its impact on recurrence. This prospective study was conducted in the department of Urology at a tertiary institution from August 2021 to April 2023. The main aim was to determine the benefit of addition of NBI during TURBT in NMIBC. All patients with Urinary Bladder Mass (size less than 5 cm on USG/CT) aged >18 years of age planned for TURBT were included. Amongst 63 patients, the mean age was 59.84 ± 11.3 years; 80% were males. Sixty percent of patients had history of Tobacco consumption and Type II DM was the most common comorbidity (59%). Commonest symptom was gross haematuria. Posterior wall was most commonly involved and papillary lesions were commonest. A total of 125 lesions were identified on WLI, with mean 1.98 ± 1.75 and 78 additional lesions were identified only on NBI with mean 1.24 ± 1.63 lesions. Four patients had intra-operative complications. Five patients had recurrence at 6 weeks and eight patients had recurrence at 3 months. NBI had detected more lesions in patients who developed recurrence at 6 weeks and 3 months (mean: 1.41 and 1.43). NBI has additive role in detecting NMIBC lesions missed on WLI. NBI has significant role in preventing recurrence at 3 months and more so by detecting high grade tumours.

Bladder endometriosis – diagnostic and management challenges: A case report

Background: Urinary tract endometriosis (UTE) is the presence of endometriotic implants in the bladder,ureter, kidneys, or urethra. It affects ~1% of women with endometriosis and occurs more commonlyamong those with deep infiltrative endometriosis. Bladder endometriosis is the most commonpresentation, comprising 85% of cases. Concomitant involvement of the bladder and ureter is rare,comprising 1.4% of all cases. The clinical presentation involves lower urinary tract symptoms, thatworsen during menses. Timely diagnosis and treatment are crucial in ameliorating symptoms andpreventing complications, such as obstructive nephropathy. This is a case of bladder endometriosis withureteral involvement, outlining management challenges, reviewing evidence on managementapproaches, and highlighting the experience gained from this case in managing complex UTE.Case presentation: A 38-year-old female presented with a longstanding history of pelvic pain, dysuria,and new-onset voiding difficulty. She had undergone two prior surgical procedures for endometriosis,including a total abdominal hysterectomy. Her physical examination was normal. Ultrasound revealed a3-cm intracavitary bladder mass, which was described as likely endometriosis on magnetic resonanceimaging. On cystoscopy the mass was noted to be larger, encasing the left ureteric meatus. Alaparoscopic cystostomy was performed, with partial resection of the mass and placement of a temporaryureteric stent. After three months of medical treatment with dienogest, cystoscopy revealed a significantreduction in size with sub-centimeter residual avascular tissue. This was resected avoiding the ureter andureteric meatus. A new ureteric stent was placed. A repeat cystoscopy three months later revealed goodhealing with no residual endometriosis. The stent was removed, and a retrograde pyelogram confirmedno meatal stenosis or ureteric obstruction. She has remained symptom-free.Conclusion: Medical and surgical options are available for bladder endometriosis, with partialcystectomy being the gold standard. The initial approach is dependent on the size of the lesion and theextent of ureteric involvement. A staged approach that combines medical or surgical management canensure optimal outcomes while reducing surgery-associated morbidity in complex cases.

Bladder endometriosis-A great masquerader

The bladder is the most common site affected in urinary tract endometriosis. There is a controversy regarding the pathogenesis, clinical management (diagnosis and treatment), impact on fertility, and the risk of malignant transformation of bladder endometriosis. Patients presenting with symptoms typically attributed to endometriosis might go unnoticed because of its infrequent occurrence. We, hereby, report a case of a young female who had complaints of burning micturition and dysmenorrhea. After a thorough evaluation, she was found to have a urinary bladder mass which was subjected to a biopsy. The initial histopathology report came as bladder malignancy but immunohistochemistry proved otherwise and it turned out to be urinary bladder endometriosis.

Cystitis Glandularis as A Solid Mass in Bladder - A Case Report

Cystitis Glandularis as A Solid Mass in Bladder - A Case Report

A Rare Case of Endometriosis in Urinary Bladder

Endometriosis with involvement of urinary tract is a rare occurrence. It is a chronic condition with presence of endometrial tissue outside uterine cavity. Most likely location is peritoneal surface of pelvis. We present a case of 32 year old female presenting with pelvic pain. On sonography bladder mass was detected. Transurethral resection of bladder mass revealed foci of endometriosis with mild inflammation in stroma. The diagnosis relies on identification of atleast two of the three components: endometrial glands, endometrial stromal cells or recent or old haemorrhage. Endometriosis with minimal stroma should be differentiated from invasive adenocarcinoma of the bladder. This case reports demonstrates that endometriosis in bladder although rare should always be ruled out by proper histological examination and save patient from unnecessary overtreatment.

Incidental diagnosis of microfilariae in urine in a case of prostatic carcinoma: A case report with a cytohistological correlation

Filariasis is an endemic parasitic infection commonly found in the tropics and subtropics, such as India. Microfilariae have been reported in various cytological samples, but they are rare to find in urine samples. The presence of microfilariae in urine can be incidental or associated with other malignancies. The cytological examination can help diagnose such cases. Clinically, it may present unusually as achylous hematuria and a urinary bladder mass lesion, mimicking bladder cancer. There have been a few reported cases of microfilariae in urine along with prostatic malignancy, and the present case highlights the same. Here, we report a treated case of metastatic prostatic carcinoma presenting as a bladder mass in a 61-year-old male, who was diagnosed with microfilariasis in urine cytology. This case is presented not only for its dual pathology or rare occurrence but also to emphasize that an incidental finding can help in treating it medically with no surgical intervention.