Case Study

Bladder mass in a 15 year old MN dog with persistent hematuria

A 15-year-old MN dog was presented for persistent hematuria. On physical examination, a cardiac murmur was present. The only abnormality on urinalysis was an inappropriate SG. Elevated ALP activity was present on serum biochemistry. Low-dose dexamethasone suppression test and blood pressure were both within normal limits.

Sonographic Differential Diagnosis

Aggressive, highly vascular mass with mineralization in the cystourethral junction, urinary bladder urethra and prostate. This mass is non-resectable. The appearance of this mass is highly suggestive for transitional cell carcinoma or prostatic adenocarcinoma.

Image Interpretation

The bladder in this patient contained a 4 x 2.4 cm luminal bladder mass that occupied the caudal aspect of the bladder and invaded into the cystourethral junction, urethra, and prostate. Significant power Doppler signal was noted, indicative of high vasculature.

DX

Consistent with prostatic carcinoma, necrosis and chronic hemorrhage.

Outcome

Patient was lost to follow up.

Comments

Imaging the thorax and abdomen is recommended as metastasis to the lumbar vertebrae and/or pelvis is common, and metastasis to the lungs can also occur. The prognosis for dogs with prostatic adenocarcinoma is poor, with typical survival of 1 – 2 months after diagnosis. The disease is usually diffuse within the gland, and often has metastasized at the time of diagnosis. Surgical resection is not a good option for the dog, because it results in permanent urinary incontinence, and is unlikely to cure the cancer. Radiation therapy may improve the survival time, but local side effects such as colitis, urethritis and cystitis make this option less than ideal. Chemotherapy may be the best option, but current protocols are not very successful. Recommend primary treatment for the bladder mass in this patient using urethral stents. Piroxicam therapy could be considered for palliative therapy as well.

Clinical Differential Diagnosis

Hematuria – bladder pathology (neoplasia, cystitis, uroliths), prostatic disease (neoplasia, infection), urethral pathology (neoplasia, urethritis). Heart murmur – most likely mitral/tricuspid insufficiency.