A 57-year-old Caucasian female patient was admitted to the vascular surgery service due to deep venous thrombosis.
During the physical examination, they detected a tumefaction hypogastric and collaboration to the Urology Department.
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The patient had no personal or family history of disease.
She never came to the doctor.
Physical examination revealed a hypogastric swelling of the membranous, friable, reddish mucosa with whitish areas suggestive of bladder exstrophy.
Diastasis of the rectus abdominis muscles and symphysis pubis was observed.
Vaginal and rectal examination was normal.
Laboratory tests showed normocytic normochronic anemia with normal renal and hepatic function values.
Alkaline phosphatase was normal.
Abdominal-pelvic CT scan revealed an extrophic bladder plaque with diastasis of both pubic branches.
No lymph nodes were present.
Diastasis of both pubic branches, kidneys, liver, spleen and pancreas were within normal limits.
A multiple bladder biopsy was performed with a histological diagnosis of moderately differentiated adenocarcinoma.
Anterior pelvic exanthenation (primary cystoanexectomy radical) was performed with bilateral ileo-obturator lymphadenectomy, abdominal wall resection, Bricker type urinary diversion (ureteroileostomy).
The postoperative period was normal.
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The histological description shows chronic cervicitis lesions and some erosions in the endo-exocervical transition.
Myometrium is normal and endometrium is inactive.
The specimen presents moderately differentiated adenocarcinoma of the classic glandular type with focal areas of clear cells.
Signaling structures present extensive areas of necrosis and consolidation and are accompanied by mild stromal reaction.
Invasion of the muscularis propria of the organ is observed without reaching adjacent soft tissues.
Focal areas with surface epithelium showing squamous metaplasia images are also observed.
In conclusion, it is a moderately differentiated adenocarcinoma of the bladder, with isolated muscularis propria.
There were no lymph nodes suggestive of pT2bN0Mx metastases.
After six months of follow-up, the patient presented intestinal eventration awaiting surgical correction, without recurrence.
