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Images
in Women's Health
June 2003
Saju D. Joy, MD; Douglas Swartz, MD; Andrew M. Kaunitz,
MD
Case
During an annual gynecologic examination, a 58-year-old woman noted
that continuous spotting was occurring on combined menopausal hormone
therapy. An ultrasound examination revealed normal uterine and adnexal
findings. However, abdominal imaging revealed multiple soft tissue
masses at right lateral bladder wall ranging in size from 1.3 x
1.4 x 1.5 cm to 2.0 x 1.4 x 1.6 cm (Figure 1).
Subsequent cystoscopic findings (Figure 2) revealed a 2 cm pedunculated,
superficial bladder tumor with a narrow stalk. The tumor was excised
cystoscopically and the biopsy revealed a low-grade I papillary
transitional cell carcinoma without invasion. Her most recent cystoscopic
examination, 1 year from initial treatment, revealed normal findings.
FIGURE 1.
Ultrasound finding of bladder carcinoma (arrows) – saggital
(A) and transverse (B) views. |
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FIGURE 2.
Cystoscopic findings of grade I papillary transitional cell
bladder carcinoma. |
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Discussion
The urinary bladder is often ignored during pelvic sonography or
used strictly as an acoustic window to view deeper pelvic structures.1
Distending the bladder during abdominal ultrasonography of the
pelvis, allows optimal evaluation.2 Exophytic bladder
tumors are imaged as focal filling defects while infiltrating tumors
show little intraluminal components and are harder to identify.
Tumor echogenicity is less than that of the bladder wall and varies
from that of other organs; hence, these tumors are easily identified
or outlined from the surrounding structures.3
By remaining alert to the possibility of identifying clinically
unsuspected tumors during routine pelvic sonography, obstetric and
gynecologic sonographers can expedite the diagnosis of these relatively
uncommon but important lesions.
References:
- Dershaw DD, Scher HI. Sonography in evaluation
of carcinoma of bladder. Urology. 1987;29(4):454-457.
- Dennery MP, Rushton HG, Belman AB. Sonography
for the detection and follow-up of primary nonsarcomatous bladder
tumors in children. Urology. 2002;59(1):121-122.
- Abu-Yousef MM, Narayana AS, Franken EA Jr, Brown
RC. Urinary bladder tumors studied by cystosonography. Part I:
Detection. Radiology. 1984;153(1):223-226.
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