膀胱憩室尿路上皮癌－病例報告

李思恩、裘坤元

台中榮民總醫院，外科部，泌尿外科

Urothelial carcinoma of diverticulum located over left urinary bladder wall near ureteral orifice: A case report

Sz-En Lee, Kun-Yuan Chiu

Taichung Veterans General Hospital

Introduction

A urinary bladder diverticulum is an outpouching of the bladder urothelium and mucosa through the muscularis propria layer, which can increase the chance of chronic inflammation, infection or even malignant neoplastic change due to  poorly empties. Intradiverticular neoplasm has been reported with the incidence of 0.8% to 10% in previous studies and the main clinical manifestation is painless gross hematuria.  

Case report

A 63-year-old male patient with underlying diseases of hypertension with irregular medication control suffered from painless gross hematuria for about 3 months. He denied herb usage nor hair dye usage. However, he used to be a heavy smoker and quit for 15 years. According to his statement, several episodes of gross hematuria during the past one year were noted and the symptom worsening during the last 3 months.

Initial blood test revealed a white blood cell count of 4.7× 109/L, Hb level 15.1g/dl. Urine analysis showed numerous RBC. A multiphasic computed tomography scan showed a diverticulum (2.5 x 3.5 cm) with a narrow neck connected to the left ureteral orifice region. 

Multiple bladder tumors were also noticed. The patient underwent TURBt for the first and biopsy over left ureter orifice was conducted at the same time. The biopsy pathology revealed high grade papillary urothelial carcinoma. After discussing with the patient, robotic-assisted partial cystectomy and distal ureterectomy with transureteroureterostomy was conducted  2 weeks later. The surgical pathology present high grade papillary urothelial carcinom and tumor invaded to muscularis propria. pT2NxG3. The procedure went on smoothly and the patient was discharged a week later. Now the patient is undergoing adjuvant chemotherapy regularly.

Conclusion

Urothelial carcinoma within bladder diverticulum could be difficult to diagnosis. In our case, image plays an important role in identifying bladder diverticulum. A partial cystectomy treatment can be achieved and vigilant cystocopy followed is suggested.