Contributed by Muammar Arida, MD and Drazen Jukic, MD, PhD
Published on line in May 2001
The patient is an 82-year-old woman who presented with severe right-sided hydronephrosis. The patient had a past history of hysterectomy and left oophorectomy many years ago. She had never been irradiated. Cystoscopy showed bladder mural thickening. A bladder biopsy showed high-grade carcinoma. A complete metastatic workup was performed and included mammograms and upper and lower endoscopy. Clinically, the tumor was felt to be a bladder primary. A radical cystectomy and bilateral pelvic lymphadenectomy was performed.
The radical cystectomy consisted of a bladder that measured 6 cm. in maximum open circumference attached to a small portion of urethra. The right fallopian tube was adherent to the serosal surface of the bladder and was attached to a grossly unremarkable ovary at its distal end. On opening, the bladder mucosa showed a tan and brown elevated ulcerated lesion, measuring 3 x 2 cm, located 2 cm away from the bladder neck. On cut section, the lesion was ill defined tan and rubbery. The corresponding vesical wall was fibrotic and thickened with the right fallopian tube adherent to the serosa.