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Best Cases from the AFIP

Plexiform Neurofibroma of the Bladder¹

¹ From the Department of Medical Imaging, Hospital for Sick Children, Toronto, Ontario, Canada. Received July 22, 2003; revision requested August 18 and received September 24; accepted September 25. All authors have no financial relationships to disclose. Address correspondence to L.M.W., 1330 West Ave, #3005, Miami Beach, FL 33139 (e-mail: wilkinlm@hotmail.com).

View larger version (104K): [in a new window]   Figure 1a.  Axial delayed CT scans obtained with intravenous and rectal contrast material show hydronephrosis (a), which was secondary to a large predominantly hypoattenuating mass in the bladder wall (b).

View larger version (102K): [in a new window]   Figure 1b.  Axial delayed CT scans obtained with intravenous and rectal contrast material show hydronephrosis (a), which was secondary to a large predominantly hypoattenuating mass in the bladder wall (b).

View larger version (90K): [in a new window]   Figure 2.  Axial T1-weighted MR image shows the bladder mass, which has predominantly low signal intensity.

View larger version (131K): [in a new window]   Figure 3a.  Sagittal (a) and axial (b) T2-weighted MR images show that the mass contains multiple areas of low signal intensity centrally and high signal intensity peripherally (arrow in a). This finding is referred to as the target sign and is suggestive of plexiform neurofibroma.

View larger version (107K): [in a new window]   Figure 3b.  Sagittal (a) and axial (b) T2-weighted MR images show that the mass contains multiple areas of low signal intensity centrally and high signal intensity peripherally (arrow in a). This finding is referred to as the target sign and is suggestive of plexiform neurofibroma.

View larger version (106K): [in a new window]   Figure 4a.  Axial unenhanced (a) and gadolinium-enhanced (b) MR images show mild nonuniform enhancement of the large bladder mass.

View larger version (94K): [in a new window]   Figure 4b.  Axial unenhanced (a) and gadolinium-enhanced (b) MR images show mild nonuniform enhancement of the large bladder mass.

View larger version (134K): [in a new window]   Figure 5.  Horizontally oriented cross section of the tumor shows the bladder mucosa (M) surrounded by masses of nodules. Arrows = locations of the ureteric orifices. (Scale is in centimeters.)

View larger version (166K): [in a new window]   Figure 6a.  (a) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows that the oval plexiform neurofibroma (PNF) has a denser outer core with areas that have a looser configuration. It is surrounded by fibrous tissue and pushes aside elongated smooth muscle cells (SM). (b) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows that the plexiform neurofibroma (PNF) has variable architecture. On the right, the tumor cells have a wavy, parallel arrangement; on the left, the cells are arranged more loosely and haphazardly. There is no true capsule. The tumor pushes aside bundles of smooth muscle cells (SM).

View larger version (179K): [in a new window]   Figure 6b.  (a) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows that the oval plexiform neurofibroma (PNF) has a denser outer core with areas that have a looser configuration. It is surrounded by fibrous tissue and pushes aside elongated smooth muscle cells (SM). (b) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows that the plexiform neurofibroma (PNF) has variable architecture. On the right, the tumor cells have a wavy, parallel arrangement; on the left, the cells are arranged more loosely and haphazardly. There is no true capsule. The tumor pushes aside bundles of smooth muscle cells (SM).