Multipathogenetic Origin of a Pelvic Mass

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Presentation transcript:

Multipathogenetic Origin of a Pelvic Mass Marco Oderda, Paolo Mondino, Andrea Zitella, Dario Vigna, Chiara Fiorito, Donatella Pacchioni, Alessandro Tizzani, Paolo Gontero European Urology Volume 55, Issue 5, Pages 1224-1228 (May 2009) DOI: 10.1016/j.eururo.2008.12.023 Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 1 Abdominal computed tomography picture showing a large bladder stone and a supravesical cystic mass. European Urology 2009 55, 1224-1228DOI: (10.1016/j.eururo.2008.12.023) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 2 Intraoperative image showing the voluminous bladder cancer after removal of the stone. The supravesical mass has been removed. The thick bladder wall shows a large laceration that occurred during the surgical manoeuvres. European Urology 2009 55, 1224-1228DOI: (10.1016/j.eururo.2008.12.023) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 3 Pathologic sample of the supravesical cystic mass: fibromuscular wall with sclerosis (deeper part in upper inset) and superficial ulceration (lower inset) at low power magnification. This pattern is consistent with a urachal cyst. European Urology 2009 55, 1224-1228DOI: (10.1016/j.eururo.2008.12.023) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 4 Pathologic sample of a large papillary lesion surrounding the bladder stone and occupying most of the bladder surface: high-grade transitional cell carcinoma. European Urology 2009 55, 1224-1228DOI: (10.1016/j.eururo.2008.12.023) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 5 Voiding phase of the videourodynamic investigation: bilateral grade 4 vesicoureteral reflux. The bladder neck is widely opened. European Urology 2009 55, 1224-1228DOI: (10.1016/j.eururo.2008.12.023) Copyright © 2009 European Association of Urology Terms and Conditions

Fig. 6 Videourodynamic results show no signs of detrusor overactivity, a slight reduction of the vesical compliance, and a normal voiding phase (maximal flow rate: 43ml/s). The vesical catheter is ejected immediately after the onset of micturition. The morphology of the abdominal pressure curve shows a slight increase consistent with abdominal strain. During the voiding phase, the bladder neck relaxes normally without evidence of urethral stricture. Overall, urodynamic parameters rule out a bladder outlet obstruction. European Urology 2009 55, 1224-1228DOI: (10.1016/j.eururo.2008.12.023) Copyright © 2009 European Association of Urology Terms and Conditions