A case of Urothelial carcinoma , diagnosed on USG at alnoor institute of radiology and later CT done to confirm and see the extent of disease .

1. Dr Saleem Muhammad Mansha
PGR MCPS (Radiology)
Alnoor Institute of Radiology

2. Mrs. R 75Y/F presented with h/o
hematurea on 25th October
USG performed at ANDC showed bladder
mass causing Left obstructive uropathy

7. Normal bladder wall thickness is
defined as < 5 mm in nondistended
bladders
AND
< 3 mm in well-distended
bladders.

8. Neoplastic
 Urothelial Carcinoma
 Lymphoma.
 Metastases.
 Neurofibromatosis.
 Lipoma , Leiomyoma
 Hemangioma , Lymphangioma
 Fibroma , Fibromyoma
 Direct involvement by surrounding tumor
( Rectum, Prostate, Cervix)

9. Inflammatory
1. Any cause of cystitis – e.g. radiation,
infection.
2. Tuberculosis.
3. Schistosomiasis.
4. Malakoplakia.
5. Inflammatory bowel disease,
appendicitis, focal diverticulitis.

10. Muscular hypertrophy
1. Neurogenic bladder.
2. Bladder outlet obstruction – benign
prostatic hypertrophy,
urethral stricture, posterior urethral valves.
Trauma
Haemorrhage/haematoma – bleeding
diatheses, iatrogenic.

11. Chronic Cystitis
Gross wall thickness , vesicoureteric reflux
and reduction in bladder capacity
Cluster of hyperplastic urothelial cells in
submucosa
Central necrosis => Cystitis Cystica
Glandular appearance of cell cluster =>
Cytitis Glandularis

12. Viral Infection
Adenovirus
Polypoidal mass on USG
Malakoplakia
Chronic granulomatous disease
5-10 mm sessile plaques
Tuberculosis
Hematogenous spread from Lungs
Irregular mural thickening , later fibrosis

13. Schistosomiasis
Malaise , Fever , Dysurea , Hematurea
USG may show wall thickening and single
or multiple polypoidal lesions which may
be sessile or wave-like .
May show calcifications and fibrosis in
later stage
Predispose to bladder cancer of any type
especially squamous cell carcinoma

14. Affects adults from 50 to 69 years
95% are transitional cell carcinoma, 4%
squamous cell carcinoma
and 1% adenocarcinoma.
Male to female predominance of 3:1

15. Strong association with smoking, analgesic
abuse,
urothelial atypia or dysplasia (for
example, cystitis glandularis),
previous radiotherapy and a number of
carcinogens, particularly
encountered in rubber workers.

16. Chronic irritation of any sort is
associated with an increased risk of
urothelial metaplasia and
malignancy, particularly squamous cell
carcinoma.
This is seen in
schistosomiasis, recurrent cystitis,
especially with calculi, neurogenic
bladders and long-term catheterisation.

17. TNM staging of bladder
carcinoma
 T1 Invades subepithelial connective tissue
 T2 Invades muscle
 T2a Invades superficial muscle (inner half)
 T2b Invades deep muscle (outer half)
 T3 Invades perivesical tissue
 T3a Microscopically
 T3b Macroscopically (extravesical mass)
 T4 Invades any of following: prostate, uterus, vagina, pelvic wall,
 abdominal wall
 T4a Invades prostate or uterus or vagina
 T4b Invades pelvic wall or abdominal wall
 N1 Metastasis in a single lymph node 2 cm or less in greatest
dimension
 N2 Metastasis in a single lymph node >2 cm but 5 cm in greatest
dimension, or multiple lymph nodes, none >5 cm in greatest
dimension
 M1 Distant metastasis

18. IVU
USG
Cystoscopy
CT
MRI

19. Increased Urinary Bladder wall thickness
can be caused by Neoplastic , Obstructive
, Inflammatory or Traumatic causes. IVU
and USG can often give initial diagnosis
but CT and MRI are often needed to
confirm the diagnosis or to see the extent
of disease.