A 73-year-old male with a history of ischemic heart disease who underwent surgery with 3-vessel revascularization and hypertension under medical treatment.
She consulted in the urology service for hematuria.
In VU, a trabeculated bladder with some diverticular image and a central repletion defect due to an intravesical tumor was observed.
Abdominal ultrasound : ultrasonographically cystic formation in the hypogastrium, in the theoretical path of the urethra, complex and heterogeneous with areas of greater echogenicity that seem to depend on the left wall, a small communication with the bladder
Bladder exploration was performed under anesthesia and bladder TUR for biopsy, which showed a raised lesion in papillary dome with necrosis and mucous content inside, suggestive of cystic or diverticular lesion.
The pathological result of the biopsy showed abundant mucoid material with little epithelial component.
Histologically, this component shows recessed mucus-secreting columnar epithelium papillae with pseudostratification and atypia.
The study was completed with an abdominal-pelvic CT scan: a well-defined cystic formation of approximately 6 cm in diameter was observed in the hypogastrium pelvis minor, with a smaller portion of solid contrast than real.
This lesion seems to contact the internal surface of the anterior rectus abdominis muscles and extends caudally to a supravesical-extravesical location with imprint in a bladder dome of more solid semiology.
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This situation requires surgical intervention, performing an infraumbilical-extraperitoneal midline laparotomy and performing partial cystectomy.
The pathological result of the cystectomy specimen is reported as adenocarcinoma growing with enteroid and mucinous patterns of uracal origin.
