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Pelvis » Urinary Bladder
Papillary transitional cell carcinoma of the urinary bladder
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Author(s) :
Nirvikar Dahiya, MD
 
Presentation A 78 Year old female presented with gross hematuria.
 
 
 
Caption: Sagittal of the urinary bladder
Description: A papillary lesion extends from the posterior wall of the urinary bladder.
 
 
 
Caption: Spectral Doppler of the mass
Description: Internal vascular flow in the lesion differentiates it from a blood clot which can have a similar appearance.
 
 
 
Caption: Transverse urinary bladder
Description: The inferior margin of the lesion is centered between the ureteric orifice (as indicated by the ureteric jet on color Doppler) and the lateral urinary bladder wall.
 
Differential Diagnosis Bladder carcinoma
Blood clot
 
Final Diagnosis Papillary transitional cell carcinoma
 
Discussion Patients present with hematuria which may be frank or microscopic. They may also present with dull flank pain or acute renal colic due to obstruction. Transitional cell carcinoma is predominantly a disease of older people. Men are affected three time more often than women.

Causative factors include:
  1. Tobacco from smoking
  2. Aniline, benzidine, aromatic amine and azo dyes used in textile, rubber, printing, and plastic manufacturing.
  3. Cyclophosphamide therapy
  4. Analgesic abuse
Transitional Cell Carcinoma  (TCC) is classified as papillary, infiltrating, papillary and infiltrating, or carcinoma in situ.

Ultrasound features can vary from smooth or papillary hypoechoic, soft tissue masses to focal mural nodules. Calcifications within the lesion are common. TCC may be associated with hydronephrosis secondary to obstruction of ureters. TCC has also been reported arising from the wall of a bladder diverticulum and probably urinary stasis plays a role.
 
Case References
  1. Cohen SM, Johansson SL. Epidemiology and etiology of bladder cancer. Urol Clin North Am 1992; 19:421-428.
  2. Grant DC, Dee GJ, Yoder IC, Newhouse Sonography of transitional cell carcinoma the renal pelvis. Urol Radiol 1986; 8:1-5
  3. RA Leder and NR Dunnick.Transitional cell carcinoma of the pelvicalices and ureter.Am. J. Roentgenol., Oct 1990; 155: 713 - 722.
  4. Julie H. Song, Isaac R. Francis, Joel F. Platt, Richard H. Cohan, Jamil Mohsin, Stephanie J. Kielb, Melvyn Korobkin, and James E. Montie.Bladder Tumor Detection at Virtual Cystoscopy.Radiology, Jan 2001; 218: 95 - 100.
  5. JJ Wong-You-Cheong, BJ Wagner, and CJ Davis, Jr.Transitional cell carcinoma of the urinary tract: radiologic-pathologic correlation.RadioGraphics, Jan 1998; 18: 123 - 142.
 
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