Case Study

Urethral TCC in a 12 year old FS Beagle

A 12-year-old SF Beagle with a history of urinary tract infections was presented for evaluation of lethargy and poor appetite. Previous ultrasound had shown a 0.65 cm rounded mass/polyp near the bladder neck. On follow up assessment, progressive azotemia and resolution of the mass was evident.

DX

Urethral CUJ/lower urinary mass, non resectable.

Sonographic Differential Diagnosis

Urethral CUJ/lower urinary mass, non resectable.
Age related renal changes. Minor pyelectasia in the left kidney.

Image Interpretation

The urinary bladder presented a ventral wall thickening at the cystourethral junction. Minor apical wall thickening was noted and measured 0.32 cm. The proximal urethra was slightly thickened with focal areas of mineralization noted. The thickened portion measured at least 1.5 x 1.0 cm with disruption of the ventral urethral wall.

The kidneys revealed largely normal size and structure, corticomedullary definition and ratio (cortex 1/3 of medulla) were essentially maintained with some age related loss of curvilinear patterns. The cortices presented largely uniform texture with some age related echogenic changes that are not likely of clinical significance at this time unless inflammatory sediment or proteinuria is present. Medullary echogenicity differed distinctly from that of the cortex. The capsules were acceptably uniform for this age patient without dramatic irregularities. Slight, anechoic, cystic changes were noted with trace pyelectasia in the left kidney.

Outcome

Urethral stent placement would be ideal in this patient or traumatic catheterization to confirm suspicion of transitional cell carcinoma +/- urethral stent placement or cystoscopy. Ultrasound-guided laser ablation would be optimal. Closest facility for UGELAB would be in Ridgewood, NJ. Urethral mass presentation is at an early stage and I strongly recommend UGELAB procedure for this particular patient. Urine culture and sensitivity is warranted, yet this should not be performed from a cystocentesis given the possibility of trailing the urethral/CUJ tumor.