This is a 47-year-old patient with ankylosing spondylitis as the only pathological antecedent, with significant reduction in spinal mobility, especially at cervical level.
From the urological point of view, the first contact with the patient was for the study in August 2001 of a monosymptomatic and capricious hematuria, which after performing a urographic and ultrasonographic study of the left side aspect led to the diagnosis of 13 mm bladder.
With these findings an endoscopic resection of the mentioned neoformation was carried out in November of that same year, with the anatomopathological diagnosis of transitional carcinoma pTa G1.
The patient continues with outpatient follow-up studies and negative cytology.
In December 2003, a control cystoscopy was performed, finding the patient asymptomatic, with the diagnosis of superficial papillary tumor recurrence in the bladder floor.
The preoperative study was normal, finding in urine determination a sediment with 35 cysts/field, and 100 leukocytes/field, with a urinary pH of 7 and a normal culture negative for germs.
Three months later endoscopic resection of the recurrence was performed, which was multifocal, with the diagnosis of transitional carcinoma pTaG1.
Given the patient's age, recurrence in less than two years, and its multifocality, it was decided, despite the low tumor grade, to complete the treatment with intravesical instillation of mitomycin C.
A weekly instillation of 40 mg of Mitomycin C was scheduled for six weeks, after instillation of an early dose within 48 hours after surgery.
Tolerance to instillations is correct and is followed again in the consultation.
When the patient is asymptomatic, she is seen for review in September 2004 with a cytology of sores, but not determinants of malignancy the echographic finding of a significant thickening of the anterior bladder wall suggestive of colitis.
Moreover, in the area of the last tumor resection there is also a hyperechogenic area with an implant base of 1.5 cm, very suggestive of tumor recurrence.
Image 1
Urine culture was negative at these times, showing a urinary pH of 8, and sediment of 40 cysts/field and 120 leukocytes/field.
In October 2004 an endoscopic review under general anesthesia was performed.
Surgical findings are as follows:
- Normal capacity beam
- a deflected area with granulation tissue on the front of the bladder showing a fixed image on ultrasound
- On the left side of the bladder floor there is a pseudomelanoma with a necrotic appearance which detaches itself from the loop with a recess.
- A thickened, thin, hard mucosa appears underneath the pseudo melanoma, with a liming sensation in an area of 2 cm.
The lesion described with the suspicion that it was an endoscopic neoplasia with necrosis zones due to its appearance is resected throughout its extension.
The anatomopathological study revealed the existence of fragments of the bladder wall with intense inflammation, areas of necrosis and deposit of inorganic salts intermixed with necrotic tissue and fibrin without evidence of tumor tissue.
Muscle fibers with intense inflammation and areas of hemorrhage and necrosis were also observed, but without tumor necrosis.
Image 2
The post-operative period was uneventful, and the patient was discharged three days after the intervention for periodic follow-up in the clinic with the diagnosis of cyst in screening.
