Carcinomas in vesical diverticula: The role of ultrasound

Abstract

The vesical diverticulum (VD) consists of a cavity formed by herniation of the bladder mucosa through the muscular wall joined by a constricted neck to the bladder cavity proper.' The VD tends to occur in areas of congenital weakness of the muscular wall, and for that reason it is most common in the region around the ureteral meati or in the posterolateral surface of the bladder.2-4Vesical carcinoma (VC) is the most important malignant tumor of the urinary tract.5 The average ma1e:female ratio regarding VC is around 3:1.6 As for the VD, this ratio is 9:1.3,7 For this reason, the large majority of the reported cases of VC located in the VC are in males.The incidence of VC found within the VD ranges from 0.8% to 7%.7 The average age of male patients with VD is around 577 while that of patients with both VC and VD is 66, which is similar to the age at which extradiverticular bladder carcinoma appears.Persistent lower urinary tract obstruction is a causative factor for both VC and VD, their main etiologies being enlargement of the prostate and bladder neck s t e n~s i s .~ Other factors that have been statistically demonstrated as having an influence on the onset of VC are chronic inflammation: tobacco smoking, and occupational exposure to certain dyes and other products.6The diagnosis of these tumors frequently yields negative results with traditional m e t h o d~l~~'~ since it is often necessary to perform all the available diagnostic procedures to demonstrate the filling defect within the VD.9Three cases of VC in VD are reported here, with special remarks on the role of real-time suprapubic ultrasound in both diagnosis and staging. CASE REPORTSOur three male patients were 78,55, and 57 years old, respectively. In all three cases predisposing factors led to the development of VC and VD. Cases I and I1 had chronic lower urinary tract obstruction caused by an enlarged prostate that required transurethral resection 6 years previously. In case I1 a papilloma was resected 5 years previously. Case I11 was a heavy smoker and had urinary tract infection. Every patient had painless macroscopic hematuria as the main complaint. Apart from that, clinical and analytical evaluations were normal. The diagnostic procedures yielded the following results. Case IMild bilateral ectasia was found. A large VD on the right posterolateral surface of the bladder revealed a filling defect inside.A large VD on the right posterolateral surface was almost entirely occupied by an irregular attached solid mass, with hypoechogenic areas in it. The tumor penetrated into the diverticular wall, interrupting normal reflections. Continuity of the outer limit of the wall was preserved (Stage A-B).Cystoscopy. A large VD was found on the right posterolateral surface with purulent urine and a large solid friable neoformation covered with fibrin, which was biopsied.Histopathology. Grade IV epidermoid carcinoma with perivesical invasion (Stage C) was found.Intravenous Urography (Fig. 1). Ultrasound (Fig. 2). Case I1Intravenous Urography. Multiple small VDs...

Forced diuresis 18 F-fluorodeoxyglucose positron emission tomography/contrast enhanced in detection of carcinoma of urinary bladder diverticulum

“…[ 2 ] Ultrasonography is useful for diagnosing patients with bladder diverticulum tumors, but evaluation of tumors in the dome or neck of the bladder is difficult. [ 3 ] With CECT, nonopacification of diverticulum due to occlusion of diverticular orifice by tumor occurs limits the detection of the primary tumor in some cases. [ 4 ] High intrinsic tissue contrast between urine and the tumor in the diverticulum makes T1- and T2-weighted MRI suitable for detection of primary bladder diverticular tumor and its perivesical spread.…”