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DOI: 10.1148/rg.255045205
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Right arrow Genitourinary Radiology

Intradiverticular Bladder Carcinoma1

Eduardo J. Matta, MD, Arthur J. Kenney, MD, Gregg M. Barré, MD and Richard M. Vanlangendonck, Jr, MD

1 From the Department of Radiology, Ochsner Clinic Foundation, Jefferson, La. Received November 24, 2004; revision requested January 5, 2005, and received February 16; accepted February 25. All authors have no financial relationships to disclose.


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  		Figure 1.  Anteroposterior intravenous urogram obtained 15 minutes after injection of contrast material shows a large right-sided bladder diverticulum with a somewhat irregular lateral border superiorly (arrow).

 


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  		Figure 2a.  (a) Gray-scale US image shows the anteriorly located solid mass within the right-sided diverticulum. (b) Color Doppler image shows blood flow within the mass.

 


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  		Figure 2b.  (a) Gray-scale US image shows the anteriorly located solid mass within the right-sided diverticulum. (b) Color Doppler image shows blood flow within the mass.

 


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  		Figure 3a.  (a) Axial unenhanced CT scan shows the intradiverticular mass, which has an attenuation value of 31 HU. (b) Contrast-enhanced CT scan shows homogeneous enhancement of the mass to 51 HU.

 


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  		Figure 3b.  (a) Axial unenhanced CT scan shows the intradiverticular mass, which has an attenuation value of 31 HU. (b) Contrast-enhanced CT scan shows homogeneous enhancement of the mass to 51 HU.

 


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  		Figure 4a.  (a) Cystoscopic image shows the diverticular ostium. The intradiverticular mass can be faintly seen in the center of the ostium. (b) Cystoscopic image obtained inside the diverticulum shows the mass (top) with surrounding mucosal erythema (bottom left).

 


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  		Figure 4b.  (a) Cystoscopic image shows the diverticular ostium. The intradiverticular mass can be faintly seen in the center of the ostium. (b) Cystoscopic image obtained inside the diverticulum shows the mass (top) with surrounding mucosal erythema (bottom left).

 


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  		Figure 5a.  (a) Photograph shows the resected bladder diverticulum. The diverticular ostium (arrow) is better visualized when the tissues are lifted up with a hemostat (inset). (b) Photograph obtained after dissection shows the lobulated mass within the diverticular cavity.

 


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  		Figure 5b.  (a) Photograph shows the resected bladder diverticulum. The diverticular ostium (arrow) is better visualized when the tissues are lifted up with a hemostat (inset). (b) Photograph obtained after dissection shows the lobulated mass within the diverticular cavity.

 


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  		Figure 6a.  (a) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows papillary urothelial carcinoma (right) with papillary fronds (black arrows). Squamous differentiation (left) is associated with eosinophilic keratinous debris (white arrow). (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows papillary urothelial carcinoma (right) with papillary fronds (black arrows). Glandular signet ring cell differentiation (left) is associated with blue mucin-filled intracytoplasmic vacuoles (white arrow).

 


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  		Figure 6b.  (a) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows papillary urothelial carcinoma (right) with papillary fronds (black arrows). Squamous differentiation (left) is associated with eosinophilic keratinous debris (white arrow). (b) Photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows papillary urothelial carcinoma (right) with papillary fronds (black arrows). Glandular signet ring cell differentiation (left) is associated with blue mucin-filled intracytoplasmic vacuoles (white arrow).

 


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  		Figure 7.  Correlation of the extent of tumor invasion with the TNM staging system of the International Union against Cancer and the Jewett-Strong-Marshall (JSM) staging system. The muscular layer is missing in bladder diverticula. The reflection of peritoneum that makes up the serosal layer of the upper bladder is not shown.

 




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