PMC4891555_01
Sagittal transabdominal pelvic ultrasound shows an irregular mass (arrow) situated anterior to the uterus (U), invaginating the urinary bladder (BL) [Powerpoint Slide].
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Pelvic ultrasound revealed an irregular 4.0-cm mass anterior to and separate from the uterus, invaginating the urinary bladder (Figure 1).
Sagittal T2, axial T1, sagittal unenhanced T1, and sagittal enhanced T1-weighted MR images (A-D) demonstrate a solid mass (arrows) within the dome of the urinary bladder (BL), closely abutting but separate from the uterus (U) in the vesicouterine space. The mass is predominantly isointense compared to the normal bladder wall on the pre-contrast sequences, but does contains T1 hyperintense hemorrhagic foci inferiorly (B-C; arrowheads), consistent with bladder endometriosis [Powerpoint Slide].
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Subsequent magnetic resonance imaging (MRI) of the pelvis demonstrated the solid mass to be located within the dome of the urinary bladder, closely abutting but separate from the uterus, either arising from the superior wall or invading the bladder from the supra-vesical space (Figure 2).
Low power view of the bladder wall (Hematoxylin - Eosin stain 50X, mucosa to the right). Endometriotic glands form variably sized cysts (*) in the submucosa of the bladder and in the muscularis propria (not shown) [Powerpoint Slide].
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The patient subsequently underwent laparoscopic segmental bladder resection, with the pathologic specimen showing multiple foci of endometriosis in the bladder wall (Figure 3) and vesicovaginal septum.