PMC9149452_01
Cystoscopy and abdominal CT findings at the initial diagnosis. a Cystoscopy shows a sessile papillary tumor and edematous changes around the left wall. b CT shows left hydronephrosis due to the bladder tumor invading the left ureteral orifice (yellow arrow).
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F1
Cystoscopy revealed a sessile papillary tumor and edematous changes around the left wall of the bladder (Fig. 1a). Computed tomography (CT) revealed left hydronephrosis and a bladder tumor involving the left ureteral orifice (Fig. 1b).
Macroscopic and microscopic findings at cystectomy. a Macroscopically, tumors can be seen all around the bladder with significant extravesical invasion. b Hematoxylin and eosin staining show the malignant cells arranged in small papillary clusters in clear spaces with a high incidence of lymphovascular and vascular invasion (red arrow). The proportions were 95% micropapillary variant and 5% UC
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F2
Histopathology revealed pathological stage T4aN0M0 MPUC (UC, 5%; micropapillary variant, 95%) (Fig. 2) and incidental prostate adenocarcinoma (Gleason score 4 + 4, pathological stage T2a).
CT findings at 2 months after cystectomy and clinical course. a Local recurrence was confirmed at the pelvic floor (red arrow), associated with annular thickening of the rectal wall (yellow circle). Constipation and defecation pain was believed to be caused by bladder cancer invading the rectum. b Clinical course. After local recurrence and invasion to the rectum appeared, colostomy was performed to improve defecation symptoms. However, local recurrence progressed rapidly, and he gradually felt perineal pain due to skin metastases at 3 months after cystectomy.
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F3
Although there were no perioperative complications, the patient complained of constipation and pain on defecation due to local recurrence and invasion of the rectum 2 months after cystectomy (Fig. 3a). However, the patient died 6 months after cystectomy due to rapid metastases (Fig. 3b).