case_images: PMC9035940_01
case_images: Results of abdominal CT (a, b) and cystoscopy (c) at the initial diagnosis. CT shows bilateral hydronephrosis (a) and diffuse thickening of the bladder wall and suspicious to inflammation at retroperitoneal space (b). c Cystoscopy reveals the whole bladder mucosa is edematous change so that an atypical bladder tumor unlike conventional UC is suspected.
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case_images: F1
case_images: Computed tomography (CT) showed bilateral hydronephrosis and diffuse thickening of the bladder wall (Fig. 1a, b). Urine cytology was positive (class V), and cystoscopy revealed diffuse edematous nonpapillary tumor (Fig. 1c).
case_images: Macroscopic and histopathological findings of the TURBT specimen. Since a nonpapillary tumor with edematous change appeared, we thought it is an atypical finding unlike UC. a Nonpapillary tumor in the bladder neck. b The tumor cells shows discohesive growth with typical plasmacytoid morphology. There are marked lymphovascular invasions. c Diffuse edematous nonpapillary tumor at the posterior wall. d Hematoxylin and eosin staining. It shows the malignant cells with plasmacytoid morphology and muscle-invasive, high-grade UC. There are also high expressions of lymphovascular invasion.
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case_images: F2
case_images: Transurethral resection of bladder tumor (TURBT) for diagnosis and left percutaneous nephrostomy were performed (Fig. 2a, c). Therefore, the tumor was diagnosed with invasive PUC, high-grade, T2 (Fig. 2b, d, e).
case_images: CT findings 3 weeks after the initial diagnosis. A new metastases has appeared: (a) Lung, (b) pelvic lymph node (yellow allow), and peritoneal dissemination (yellow circle).
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case_images: F3
case_images: However, peritoneal dissemination and lung and pelvic lymph node metastases appeared on CT 3 weeks after the initial visit (Fig. 3a, b).