PMC9110233_01
(a) An axial plain abdominal computed tomography (CT) scan showed bladder wall thickening with calcification (arrow) and ascites in the rectovesical pouch (white arrowhead). (b) A coronal plain abdominal CT scan showed bladder wall thickening adjacent to the ileum (arrow). (c) A sagittal CT scan after intravesical injection of contrast medium via a urethral catheter (arrow) showed leakage of contrast medium into the abdominal cavity.
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Abdominal computed tomography (CT) revealed a thickening with calcification on the posterior wall of the bladder adjacent to the ileum along with ascites in the rectovesical pouch, suggesting a spontaneous bladder perforation into the peritoneal cavity potentially associated with a bladder tumor (Figures 1(a) and 1(b)). Contrast-enhanced CT (CECT) confirmed bladder perforation in the patient (Figure 1(c)).
(a) Intravesical endoscopic imaging revealed an elevated nodule with whitish tissue and calcification on the surface. (b) Removal of the calcification exposed fat droplets on the bottom of the cavity.
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Removal of the calcification revealed a cavity with fat droplets at the bottom of the lesion, which was likely the perforation site (Figure 2).
A contrast-enhanced abdominal computed tomography (CT) scan for staging showed bilateral iliac regional lymph node enlargement (a, arrow) and a small nodule in the peritoneum (b, arrow). (c) A T1-weighted TSE magnetic resonance imaging scan for preoperative local evaluation showed that the soft-tissue mass on the bladder wall extended to the small intestine (arrow), suggesting local invasion.
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CT on the 11th day of hospitalization with the intent of staging showed bilateral iliac regional lymph node enlargement and scattered small nodules in the peritoneum (Figures 3(a) and 3(b)). Magnetic resonance imaging (MRI) performed for preoperative local evaluation on the 24th day of hospitalization showed a slight enlargement of the bilateral iliac regional lymph nodes, small peritoneal nodules suspicious for peritoneal dissemination, and a new soft-tissue mass on the bladder wall extending to the small intestine suspicious for invasion (Figure 3(c)).
(a) A macroscopic image of the resected bladder. The bladder tumor was a raised lesion with an irregular surface, necrotic tissue, and hemorrhage (white arrowheads). (b) A macroscopic image of the lumen of the ileum separated from the bladder. There were submucosal lesions (white arrowheads), suggesting a submucosal invasion of the bladder cancer at the terminal ileum. (c) The bladder tumor was infiltrating high-grade urothelial carcinoma with partial keratinization (arrow, hematoxylin & eosin, x200). (d) The tumor in the terminal ileum had infiltrated the submucosal layer under the normal glandular structures (hematoxylin & eosin, x40).
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The specimen was a raised lesion on the posterior wall of the bladder with an irregular surface with necrotic tissue and hemorrhage (Figure 4(a)). The lesion appeared to extend to the serosa and had invaded the terminal ileum (Figure 4(b)). The pathologic diagnosis was high-grade infiltrating UC with squamous differentiation, and the pathological stage was T4bN1M1b (Figures 4(c) and 4(d)).
A postoperative contrast-enhanced abdominal computed tomography (CT) scan showed enlargement of one of the peritoneal nodules (a, arrow) and the invasion of nodules with edematous lumens to the small intestine (arrows) (b, c).
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A CT scan on the 30th day of hospitalization showed enlargement of the left obturator lymph node and rapid growth of multiple peritoneal nodules, some of which had invaded the small intestine (Figure 5).