14 year old FS DSH. Initial inappropriate urination and hematuria in October. Full workup at nearby referral hospital including blood work (mild azotemia), abdominal ultrasound (one proliferative mass appearing region ventral bladder wall 1.8 cm long and two smaller dorsal mass like/proliferative regions dorsal wall to the right in trigone region), and UA (marked hematuria and more WBCs than today, but no bacteria seen). Their working dx was polypoid cystitis. Has been on a wet food since and urinary asymptomatic but owner thinks has been losing weight.
Patient re-presented yesterday for hematuria and inappropriate urination. Now, just seeing this more mass like object in the dorsal bladder, more lateralized to the right. Renal values WNL. UA shows marked hematuria and transitional cells, but no evidence of infection.
I’m a bit confused that multple regions were seen last October and second guessing myself, but this looks more like a bladder mass to me. Owner debating about proceeding with traumatic catheterization for biopsy (previous bx attempt at referral hospital was inconclusive). Thoughts? Is lymphoma pretty low likelihood compared to TCC?
Comments
This looks like a tumor as
This looks like a tumor as opposed to cystitis as its in the wall and disrupting wall layering. Could be TCC which is always possible with bladder tumors but I think a higher chance of smooth muscle tumor, lymphoma or other as it looks to be primarily in the wall and not really looking like its arising from the surface and projecting into the lumen. Certainly possible to have concurrent cystitis as possibly indicated but the polyploid looking luminal surface adjacent to the tumor. Id consider trying to FNA. I think surgical options may be limited due to size and possible involvement of the ureteral papilla area.
Very much tcc with the
Very much tcc with the transmural penetration. Cystitis stays mucosdal while this mass occupies the entire wall destrying layers to the serosa.