Urinary Bladder Malignancy

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layers of the bladder starting closest to the lumen

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urothelium
lamina propria
muscularis propria
adventitia

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2 broad types of bladder neoplasm

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epithelial (most common)
non-epithelial (mesenchymal)

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types of benign mesenchymal bladder neoplasms

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leiomyoma
paragnaglioma
fibroma
plassmacytoma
solitary fibrous tumor
NF
lipoma

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types of malignant mesenchymal bladder neoplasms

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rhabdomyosarc
leiomyosarc
lymphoma
osteosarc

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appearance of epithlial tumors in bladder

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intraluminal filling defect

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appearance of mesenchymal tumors

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smooth intramural lesion

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another name for transitional cell CA

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urothelial cancer

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most common type of bladder CA

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TCC > squamous cell > adenoCA

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pathogenesis of TCC

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direct, prolonged contact of bladder urothelium with urine containing excreted carcinogens (esp from cigarettes)

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other than cigarette smoking, other associations of TCC

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bladder stones, chronic infx, medications
pts with bladder diverticuli

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most common location w/i bladder for TCC

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base

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types of TCC in bladder

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papillary
sessile
nodular

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at what point is TCC of bladder considered invasive

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after is goes deeper than lamina propria; once w/i muscularis layer, it is invasive

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if invasive, where does bladder TCC go

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local mets to prostate, vagina, uterus, pelvic wall
mets to pelvic LN
distant mets to lung>liver>bone

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enhancement characteristics of bladder TCC

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avidly enhance, early

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appearance of TCC on US if lesion is present

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hypoechoic
+flow

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on MR, appearance of bladder wall/tumor in TCC

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intermed on T1 and T2

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what is a strong risk factor for squamous cell CA of bladder

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schistosomiosis
also, indewlling cath, bladder calcs, chronic infx , prior cyclophosphamide

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most common location of squamous cell CA of bladder

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trigone and lateral bladder
bladder diverticula

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imaging finding of squamous cell CA of bladder

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no-specific
usually sessile

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tx of squamous cell CA

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radical cystectomy

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which prognosis is poorer: squamous cell or TCC

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squamous cell

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etiology of adenoCA of bladder

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2/3 are associated with urachal CA, 1/3 are metastatic

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how will urachal CA present clinically

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urachal d/c
mucous in the urine

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classic associations of urachal CA

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bladder exstrophy
patent urachus
pelvic lipomatosis
cystitis glandularis

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location of primary urachal CA

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bladder base > urachus

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what other types of CA can urachus present with

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80% are adeno
remainder are squamou scell and TCC

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pathophys of adenoCA of urachus

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urachus is lined with transitional epihelium. adenoCA is thought to arise in areas of intestinal metaplasia or from rests of embryonic hhindgut epithelium within urachus

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is adenoCA of bladder cystic or solid

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both in 84% of cases

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where is urachal CA most often

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outside of the bladder

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pathology of small cell bladder CA

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dedifferentiated neuroendocrine cells

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is small cell bladder CA agressive

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yes, highly agressive

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classic appearance of small cell bladder CA

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large, polypoid or nodular and may have ulcerated surface
+- central necrosis or cystic change
patchy enhancement

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most common location for small cell bladder CA

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lateral wall of bladder

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tx of small cell bladder CA

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radical cystsectomy and pelvic LN dissection

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most common location of bladder carcinoid

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bladder neck or trigone

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T or F
carcinoid syndrome is common in carcinoid bladder tumors

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false, no known reports

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how often is carcinoid of bladder metastatic

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30%
remainder are benign

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most common mesenchymal tumor of bladder

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leiomyoma

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leiomyoma more common in males or females

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equal

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general appearance of bladder leiomyoma

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small solid homogeneous mass +/- cystic degeneration
muscularis layer preserved

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MR appearance of bladder leiomyoma

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intermed T1
low T2
variable enhancement

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T or F
leiomyoma of bladder can degenerate into leiomyosarc

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false, but it does have to be bx'd to confirm dx

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most common mesenchymal malignancy in bladder

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leiomyosarcoma

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risk factors for leiomyosarc

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after radiation tx or cyclophosphamide, increased risk

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genereal appearance of leiomyosarc

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necrosis is more common
poorly circumscribed
otherwise, similar to leiomyoma

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tx of leiomyosarc

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resection

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most common bladder tumor in children

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rhabdomyosarcoma

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where can rhabdomyosarcoma occur

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anywhere in body except bone

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associated anomalies seen in pts wiht rhabdomyosarc

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congenital brain anomalies
NF
nephroblastomatosis

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general imaging features of rhabdomyosarc

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lrg nodular filling defect or mass

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most common location of rhabdomyosarc in bladder

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bladder base

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tx of rhabdomyosarc

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chemo

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#1 GU site of neurofibroma

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bladder

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which NF type is associated with bladder neurofibromas

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NF 1
although they can also occur in isolation

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where are bladder neurofibromas most commonly located
why

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trigone
nerve plexus enters near trigone and neurofibromas arise from nerve plexus

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types of bladder neurofibroma

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localized
diffuse
plexiform

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appearance of plexiform neurofibroma

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nodules on thickened nerve and branches occur
has a target appearance on T2 (caused by fibrosis surrounded by myxoid stroma)
the stroma enhances

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what is the proper name for a pheo arising outside of the adrenal gland

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paraganglioma

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clinical presentation of bladder paraganglioma

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catecholamine release during micturition

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location of paraganglioma of the bladder

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can be anywhere

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bladder paraganglioma:
benign or malig

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benign mostly
5-18% chance of malign

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general imaging features of bladder paragangliom a

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solid homogeneous lobulated well marginated mass
may have cystic areas, necrosis, or hemorrhage
submucosal location
marked enhancement
ring calcifications

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MR characteristics of bladder paraganglioma

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low T1
mod high on T2

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tx bladder paraganglioma

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tx with local excision after alpha blockade
Long term f/u rec'd.

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add'l studies to perform in pt with paraganglioma to determine extent of dz

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MIBG
PET wiht fluorodopamine (analogue of dopamine)
MR

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why is bladder lymphoma very rare

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there is no lymphoid tissue in bladder

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who is most likely to get hemangiomas of the bladder

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kids > adults
can be isolated or assoc with klippel-trenaunay-weber syndrome or sturge-weber syndrome

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most common type of hemangioma in bladder

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cavernous hemangioma

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general imaging characteristics of hemangioma (bladder)

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hypervascular
low T1, high T2

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solitary fibrous tumor - general imaging features

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solid enhancing mass
low T2 signal

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path of solitary fibrous tumor

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whorled, fibrotiic surface, similar to leiomyom a

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tx of solitary fibrous tumor

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partial cystectomy