suspect prolific bladder tumor vs. polypoid cystitis

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?

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