Imaging Findings
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 carcinoma 17%
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 occur
U/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)
Differential Diagnosis List
Carcinoma within a bladder diverticulum
Final Diagnosis
Carcinoma within a bladder diverticulum