Bladder neoplasm detected during pregnancy is a rare condition. The cardinal symptoms dysuria and hematuria are often mistakenly attributed to the pregnancy complications. Ninety percent of cases in women under 40 fortunately belong to superficial papillary urothelial neoplasm of low malignant potential (PUNLMP), known even as transitional cell cancer (TCC). Cigarette smoking, frequent urinary tract infections and environmental chemical carcinogens exposure are the most important risk factors for bladder carcinoma. A healthy 28-year-old pregnant primigravida woman, non-smoker, presented in gestational week 30+3 with intermittent painless macrohematuria, interpreted as vaginal bleeding. She underwent gynecological examinations twice without detection of any signs of bleeding. At the third examination an irregular papillary bladder neoplasm was suspected on 2D ultrasound. 3D image of the neoplasm was rendered using HDlive and the volume was measured. Colour and spectral Doppler shown a moderate vascularity with high peak systolic velocity (PSV=28cm/sec) inside of the neoplasm. Cystoscopy confirmed a suspicious neoplasm. Urine cytology was negative. In gestational week 34+0 an emergency Caesarean section was performed due to failure of induction of labour. Three days later a transurethral resection of neoplasm (TUR-B) was performed, uneventfully. Histology shown non-invasive papillary urothelial cancer (stage pTaG1). No adjuvant therapy was needed. Follow-up with cystoscopy, 4 and 10 months after treatment, were negative. Despite the rarity of bladder carcinoma during pregnancy an examination of urinary bladder should always be performed in case of atypical genital bleeding. Different diagnostic imaging as 2D and 3D ultrasound, followed by cystoscopy are sufficient and comfortable diagnostic modalities for bladder neoplasm during pregnancy. Transurethral resection of non-invasive bladder carcinoma can be performed safely either during pregnancy or after delivery.
Read full abstract