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case_images: I. Cystoscopic examination revealed nodular mass at the trigone with smooth surface near left ureteric orifice. II and III. 3-Tesla MRI revealed average sized both kidneys with mild right hydronephrosis and left moderate hydronephrosis down to thickened bladder wall more at posterior bladder wall encroaching at both ureteric orifices. Bilateral external iliac lymphadenopathy and normal both ovaries.
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case_images: Outpatient cystoscopy showed nodular lesion at the trigone near left ureteric orifice with smooth outline (Fig. 1I).
case_images: I and II bladder specimen, III and IV ovary specimen; I. Sheets of glandular structures of malignant transitional cells infiltrating lamina propria. The malignant cells exhibited marked anaplasia and pleomorphism. Foci of necrosis were evident. II. Pancytokeratin staining, neuroendocrine tumors with focal Chromogranin positivity and Synaptophysin involved in less than 10%. The adjacent mucosa was ulcerated. III. The left ovary revealed sheets of polygonal cells. The cells have abundant eosinophilic cytoplasm and rounded vesicular nuclei. IV. The left stroma is fine and vascular revealed negative pancytokeratin and diffuse positivity for Chromogranin and strong staining for Synaptophysin and inhibin.
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case_images: Synaptophysin with negative Pancytokeratin/epithelial markers (Fig. 2).Two weeks following the surgery, the patient was tested with a 24-h urinary metanephrins and was within normal limits. Six month later patient underwent MRI and bone scan for follow up and was free with no evidence of local or distant recurrence with no history of headache or palpitation with still stoppage of antihypertensive drugs.