Case 136: Carcinoma in bladder diverticulum

Subspecialty: Uroradiology
Date of Publication: 2001.12.08
Redla S, Sikdar T, Strickland NH
Hammersmith Hospitals Trust
W12 0NN - LONDON / UNITED KINGDOM

Patient:
Age: 75 year(s)
Sex: male

Clinical Summary
Painless haematuria

Clinical History and Imaging Procedures

Intermittent painless haematuria.

Discussion
This is a rare condition. 2-7% of patients with bladder diverticula develop neoplasms within the diverticulum.May be
missed on cystoscopy, hence radiological examination plays an important role in its diagnosis.Histological types :
TCC 78% Squamous carcinoma17% Adenocarcinoma 2%RADIOLOGY:Excretory Urography
& Cystography: Best visualised on post-micturition images Seen as intraluminal filling defect: D/D -
radiolucent calculi -blood clots -oedema of diverticular wall Mucosal irregularity Non-visualisation of previously
identified diverticulum Ipsilateral obstruction of upper tract may occurU/S: Useful where cystoscopy cannot be
performed.CT: Density of tumour similar to muscle Calcification occasionally occurs Early peridiverticular tumour
extension - seen as an obscuration of fat planes surrounding the neoplasm Advanced cases show tumour mass
extending into adjacent viscera and soft tissues, and nodal enlargement.MR: More accurate delineation of both the
primary neoplasm (T2W), and extravesical tumour extension due to the excellent soft tissue contrast resolution(T1W).
Significant tumour enhancement seen with gadolinium. D/D: other pelvic masses lymph nodes anteriorly sited
urachal tumour cystosarcoma phylloides small or large bowel malignancy phaeochromocytoma (no local lymph
nodes)

Final Diagnosis
Carcinoma within a bladder diverticulum

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Figure 1: Carcinoma bladder diverticulum

Figure 1a
Figures 1a - c: Axial scans through pelvis showing a soft tissue mass
indenting the postero-lateral aspect of the right side of the bladder

Figure 1b
CT section through pelvis

Figure 1c
CT section through pelvis

References:
[1] Lowe FC, Goldman SM and Osterling JE. (1989)Computerised tomography in evaluation of transitional cell
carcinoma in bladder diverticula. Urology 34:390
[2] Dondalski M, White EM, Ghahremani GG, Patel SK. (1993)Carcinoma arising in urinary bladder diverticulaAJR
161(4):817-820.

Citation:
Redla S, Sikdar T, Strickland NH (2001.12.08)
Carcinoma in bladder diverticulum, {Online}
URL: http://www.eurorad.org/case.php?id=136

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