UroToday.com - What can lie behind the quick onset on an alarming pelvic mass? In the related article, we present the extraordinary case of a 69-year-old woman, admitted in the emergency ward for abdominal pain and a bulky hypogastric mass, who was diagnosed with simultaneous diffuse bladder cancer, a voluminous bladder stone and bilateral hydroureteronephrosis.

This case represents a unique mixture of rare conditions with apparently unrelated pathogenesis, which is a diagnostic challenge. At first, the pelvic mass was thought to be consistent with urachal cyst or even urachal cancer, an uncommon malignancy with a location that often permits considerable local extension before it is discovered [1]. The possibility of a diverticulum, secondary to the bladder outlet obstruction that had favoured the huge bladder stone, was also considered [2].

At the end, however, the pelvic mass was due to an unsuspected, diffuse presentation of a transitional-cell carcinoma of the bladder, whose etiopathogenesis remains unclear. We thought of a possible relationship between the bladder cancer and the voluminous bladder stone; up-to-date, however, a definite connection between the development of bladder transitional-cell carcinoma and chronic urinary tract infections, inflammation or bladder stones remains to be established [3, 4, 5]. The mechanism of formation of the bladder stone is uncertain too, as neither bladder outlet obstruction nor detrusor hypocontractility were demonstrated in our patient in the videourodynamic study.

In conclusion, it is likely that several unrelated diseases independently contributed to the development of this unique pelvic mass.

Written by Marco Oderda, MD and Paolo Gontero, MD as part of Beyond the Abstract on UroToday.com

BIBLIOGRAPHY

1] Maletic V, Cerovic S, Lazic M, Stojanovic M, Stevanovic P. Synchronous and multiple transitional cell carcinoma of the bladder and urachal cyst. Int J Urol 2008; 15: 554-556.
2] Michelotti B, Tomaszewski JJ, Smaldone MC, Benoit RM. Bladder diverticulum arising adjacent to an ectopic ureter presenting as a cystic mass. Can J Urol 2008; 15(2):4024-6.
3] Michaud DS. Chronic inflammation and bladder cancer. Urol Oncol 2007; 25: 260-268.
4] Jhamb M, Lin J, Ballow R, Kamat AM, Grossman HB, Wu X. Urinary tract diseases and bladder cancer risk: a case-control study. Cancer causes & Control 2007. 18(8): 839-845.
5] Burin GJ, Gibb HJ, Hill RN. Human bladder cancer: evidence for a potential irritation-induced mechanism. Food Chem Toxicol. 1995;33(9):785-95.

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