PMC5480633_01
(a) Right lateral caudal abdomen projection: note the over-distended urinary bladder with irregular caudoventral margins (black arrows); air in the urinary bladder, likely iatrogenic, and kidney calcification are also visible. (b, c) Ascendant urinary tract contrast study, right lateral caudal abdomen projection: (b) normal urethra. (c) Note the filling defect and the irregular margins of the caudoventral portion of the urinary bladder
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Longitudinal scan of the urinary bladder at the level of the neck and body: note the presence of a 5.3 cm x 3.5 cm inhomogeneous oval expansive intraluminal mass; a few small irregular fluid-filled hypoechoic areas are evident. Loss of the normal structure of the dorsal wall of the urinary bladder is also visible
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On abdominal ultrasound, the urinary bladder was over-distended by the presence of an oval, vascularised mass of mixed echogenicity measuring 3.5 x 5.2 cm (Figure 2); the lesion raised from the craniodorsal aspect of the urinary bladder wall and the trigone appeared not to be involved.
(a) Macroscopic aspect of the urinary mass during intraoperative exposure: the mass was white to pink-reddish in colour with a few areas of erosion and haemorrhages on the surface; the mass was fibro-elastic in consistency. Note the thickened urinary bladder wall. (b) Macroscopic aspect of the urinary bladder wall after partial cystectomy and debulking; note the irregular aspect of the urinary bladder wall close to the urethra, which was catheterised for better visualisation during surgery
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The urinary bladder was filled by a large mass of fibroelastic consistency (Figure 3a). The mass was close to the ureter openings; therefore, after urethra catheterisation (Figure 3b) a partial cystectomy with gross debulking was performed.
Microscopic findings: presence of a proliferation of spindle cells loosely and irregularly arranged in bundles with interposition of an interstitial basophilic matrix (haematoxylin and eosin, X 20)
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The cells were loosely and irregularly disposed in bundles with interstitial basophilic matrix interposed (Figure 4); new diffuse vascularisation with red blood cell engorgement and focal haemorrhages were also seen.
Immunohistochemical staining with vimentin: note the diffuse positive staining of the cytoplasm (X 40)
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Immunohistochemistry was performed and was strongly positive for vimentin (Vimentin Ab-2, 1:100 in antibody diluent; Thermo Fisher Scientific) (Figure 5) and negative for S-100 protein (Mouse S-100 Ab-1; Thermo Fisher Scientific), Desmin (Desmin Ab-2; Thermo Fisher Scientific) and smooth muscle actin (Perossidasi DAB detection; Dako), confirming the diagnosis of fibrosarcoma.
Longitudinal scan at the site of neck and body at time of discharge: note the persistence of a 1.86 cm x 1.30 cm residual mass arising from the dorsal wall of the urinary bladder
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Abdominal ultrasound re-examination at time of discharge was characterised by the presence of a 1.86 cm x 1.30 cm inhomogeneous mass arising from the dorsal aspect of the urinary bladder wall (Figure 6).