Teaching Case

Painless haematuria

Intermittent painless haematuria.

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)