Urothelial carcinoma arising from a bladder diverticulum con
The present case has been published in the Urology Case Reports.

A 77-year old man heavy smoker known to have hypertension, diabetes type 2 and BPH on medical treatment presented with frank hematuria. History goes back to few years ago when the patient complains of recurrent hematuria that was not investigated. Examination revealed normal pulse, blood pressure, respiratory rate and temperature, Oxygen saturations were 93% on room air. Examination of the heart, chest and abdomen was normal except for palpable suprapubic hard mass. Initial blood tests included a white blood cell count of 6 × 109/L, Hb level 9.9g/dl, urine analysis shows numerous RBC.

A multiphasic computed tomography scan showed a large diverticulum with a tumor (8.2*5 cm) within it with no enlarged lymph nodes with narrow diverticular neck and multiple stones within the diverticulum (Fig. 1A and B). The patient underwent cystoscopy under anesthesia. A large bulging on the left lateral wall of the bladder was identified and the junction between the bladder and diverticulum cannot be crossed so biopsy not taken.

The cystoscopy also showed moderate bladder trabeculation and no other diverticuli. In a second procedure after discussing the treatment plan with the patient and his family and with the difficulty to reliably predict stage and grade preoperatively a decision to do partial cystectomy with bilateral pelvic lymph node dissection is made (Fig. 2). The pathology revealed high grade papillary urothelial carcinoma with no muscularis propria identified and negative lymphe node (Fig. 3). After 6 months, patient underwent cystoscopy for control that was free of tumor recurrence.

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