DOI: 10.1148/rg.262055172
Neoplasms of the Urinary Bladder: Radiologic-Pathologic Correlation1
Jade J. Wong-You–Cheong, MD,
Paula J. Woodward, MD,
Maria A. Manning, MD and
Isabell A. Sesterhenn, MD
1 From the Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201-1595 (J.J.W.); and the Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC (P.J.W., M.A.M., I.A.S.). Received September 19, 2005; revision requested September 29; revision received and accepted October 31. All authors have no financial relationships to disclose.
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Figure 1. Normal bladder wall. Diagram shows the urothelium (a), lamina propria (b), muscularis propria (detrusor muscle) (c), and adventitia (d).
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Figure 2. Diverticular tumor. Axial CT image shows a urothelial tumor (arrow) within a bladder diverticulum. Urinary stasis occurs with bladder diverticula, thus predisposing them to tumor development.
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Figure 3. Urothelial carcinoma in situ. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows the normal urothelial lining replaced by irregular cells (arrows) with marked nuclear anaplasia and loss of cell polarity. There is no invasion into the underlying lamina propria.
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Figure 4. Papillary urothelial neoplasm of low malignant potential. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows papillary fronds lined by thickened urothelium without cellular atypia.
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Figure 5. Papillary urothelial carcinoma. Cystoscopic photograph shows a frondlike mass fungating into the bladder lumen.
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Figure 6. Multicentric urothelial carcinoma. Anteroposterior radiograph obtained during retrograde pyelography shows irregular filling defects in both the bladder (straight arrow) and the renal pelvis (curved arrows).
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Figure 7. Multicentric urothelial carcinoma. Photograph of the bladder shows multiple synchronous tumors (arrows).
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Figure 8. Diagram shows the stages of tumor invasion in bladder cancer. Tumors are considered superficial if they do not extend beyond the lamina propria (T1 or less). Once the muscle layer (muscularis propria) has been invaded (T2a or greater), the tumor is considered invasive.
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Figure 9. Urothelial carcinoma. Longitudinal US image of the bladder shows a large, hypoechoic urothelial carcinoma (arrow) within the bladder.
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Figure 10. Urothelial carcinoma. Axial CT image shows a large, lobular mass within the bladder.
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Figure 11. Urothelial carcinoma. Axial CT image of the bladder shows an enhancing area of focal wall thickening (arrow), which represents a urothelial carcinoma. Flat lesions are more difficult to detect with radiologic studies, especially if the bladder lumen is not well distended.
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Figure 12. Urothelial carcinoma. Axial CT image of the bladder shows a large urothelial carcinoma. There is irregular soft-tissue stranding (arrows) from tumor invasion into the perivesical fat.
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Figure 13a. Noninvasive papillary urothelial tumor. (a) Coronal T2-weighted MR image shows an intermediate-signal-intensity mass (arrow) within the bladder lumen. The hypointense bladder wall is intact. (b) Coronal early phase gadolinium-enhanced dynamic T1-weighted MR image shows that the tumor enhances more than the bladder wall (arrow).
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Figure 13b. Noninvasive papillary urothelial tumor. (a) Coronal T2-weighted MR image shows an intermediate-signal-intensity mass (arrow) within the bladder lumen. The hypointense bladder wall is intact. (b) Coronal early phase gadolinium-enhanced dynamic T1-weighted MR image shows that the tumor enhances more than the bladder wall (arrow).
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Figure 14. Invasive urothelial carcinoma. Axial gadolinium-enhanced fat-suppressed T1-weighted MR image of the bladder shows tumor invasion into the perivesical fat (arrows).
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Figure 15. Squamous cell carcinoma associated with schistosomiasis. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows a well-differentiated squamous cell carcinoma (arrow) infiltrating the muscularis propria. Adjacent to it are Schistosoma eggs (arrowheads), most of which are calcified.
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Figure 16a. Squamous cell carcinoma in a paraplegic patient. (a) Axial unenhanced CT image shows a suprapubic catheter (arrow) entering the bladder. (b) Axial unenhanced CT image of the bladder shows calcifications (arrow) encrusting a tumor. (c) Axial contrast material–enhanced CT cystogram shows the tumor (arrow) more clearly. Note the loss of trabecular structure in the bones and the fatty infiltration of the muscles.
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Figure 16b. Squamous cell carcinoma in a paraplegic patient. (a) Axial unenhanced CT image shows a suprapubic catheter (arrow) entering the bladder. (b) Axial unenhanced CT image of the bladder shows calcifications (arrow) encrusting a tumor. (c) Axial contrast material–enhanced CT cystogram shows the tumor (arrow) more clearly. Note the loss of trabecular structure in the bones and the fatty infiltration of the muscles.
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Figure 16c. Squamous cell carcinoma in a paraplegic patient. (a) Axial unenhanced CT image shows a suprapubic catheter (arrow) entering the bladder. (b) Axial unenhanced CT image of the bladder shows calcifications (arrow) encrusting a tumor. (c) Axial contrast material–enhanced CT cystogram shows the tumor (arrow) more clearly. Note the loss of trabecular structure in the bones and the fatty infiltration of the muscles.
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Figure 17a. Squamous cell carcinoma. (a) Axial T1-weighted MR image shows lobular thickening of the lateral bladder wall (arrows). (b) Sagittal gadolinium-enhanced fat-suppressed T1-weighted MR image shows thickening of the anterior and posterior bladder walls (arrows). Pathologic evaluation showed chronic inflammatory changes with diffuse invasive squamous cell carcinoma. Inflammatory changes may make evaluation of tumor extension difficult.
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Figure 17b. Squamous cell carcinoma. (a) Axial T1-weighted MR image shows lobular thickening of the lateral bladder wall (arrows). (b) Sagittal gadolinium-enhanced fat-suppressed T1-weighted MR image shows thickening of the anterior and posterior bladder walls (arrows). Pathologic evaluation showed chronic inflammatory changes with diffuse invasive squamous cell carcinoma. Inflammatory changes may make evaluation of tumor extension difficult.
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Figure 18a. Invasive squamous cell carcinoma. (a) Axial T2-weighted MR image shows a soft-tissue mass (straight arrows) filling the pelvis and obliterating the normal bladder lumen. The mass is locally aggressive and has eroded through the abdominal wall (curved arrow). (b) Sagittal T2-weighted MR image shows urine tracking along the upper edge of the tumor (arrows). Urine was noted to be pooling on the patient’s abdomen. (c) Photograph of the patient’s abdomen shows the fungating mass.
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Figure 18b. Invasive squamous cell carcinoma. (a) Axial T2-weighted MR image shows a soft-tissue mass (straight arrows) filling the pelvis and obliterating the normal bladder lumen. The mass is locally aggressive and has eroded through the abdominal wall (curved arrow). (b) Sagittal T2-weighted MR image shows urine tracking along the upper edge of the tumor (arrows). Urine was noted to be pooling on the patient’s abdomen. (c) Photograph of the patient’s abdomen shows the fungating mass.
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Figure 18c. Invasive squamous cell carcinoma. (a) Axial T2-weighted MR image shows a soft-tissue mass (straight arrows) filling the pelvis and obliterating the normal bladder lumen. The mass is locally aggressive and has eroded through the abdominal wall (curved arrow). (b) Sagittal T2-weighted MR image shows urine tracking along the upper edge of the tumor (arrows). Urine was noted to be pooling on the patient’s abdomen. (c) Photograph of the patient’s abdomen shows the fungating mass.
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Figure 19a. Adenocarcinoma. (a) Axial CT image shows diffuse thickening of the bladder wall. (b) Axial CT image of the upper abdomen shows similar thickening of the wall of the gastric antrum (arrows). Ascites is present as well. (c) Photograph of the bladder wall shows diffuse smooth thickening, an appearance typical of linitis plastica. Autopsy evaluation of the stomach and bladder showed adenocarcinoma; it was not possible to determine which location was the site of the primary tumor.
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Figure 19b. Adenocarcinoma. (a) Axial CT image shows diffuse thickening of the bladder wall. (b) Axial CT image of the upper abdomen shows similar thickening of the wall of the gastric antrum (arrows). Ascites is present as well. (c) Photograph of the bladder wall shows diffuse smooth thickening, an appearance typical of linitis plastica. Autopsy evaluation of the stomach and bladder showed adenocarcinoma; it was not possible to determine which location was the site of the primary tumor.
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Figure 19c. Adenocarcinoma. (a) Axial CT image shows diffuse thickening of the bladder wall. (b) Axial CT image of the upper abdomen shows similar thickening of the wall of the gastric antrum (arrows). Ascites is present as well. (c) Photograph of the bladder wall shows diffuse smooth thickening, an appearance typical of linitis plastica. Autopsy evaluation of the stomach and bladder showed adenocarcinoma; it was not possible to determine which location was the site of the primary tumor.
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Figure 20a. Urachal adenocarcinoma. (a) Axial CT image shows a midline, low-attenuation, soft-tissue mass involving the dome of the bladder. Note the peripheral calcifications (arrow). (b) Photograph of the pathologic specimen shows that the surgical resection extended from the bladder dome mass (arrowheads) up to the umbilicus (arrow).
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Figure 20b. Urachal adenocarcinoma. (a) Axial CT image shows a midline, low-attenuation, soft-tissue mass involving the dome of the bladder. Note the peripheral calcifications (arrow). (b) Photograph of the pathologic specimen shows that the surgical resection extended from the bladder dome mass (arrowheads) up to the umbilicus (arrow).
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Figure 21a. Urachal adenocarcinoma. (a) Axial CT image shows a large, predominantly solid, midline mass with peripheral calcifications (arrowheads). Within the mass are scattered low-attenuation areas (arrows), which represent mucin. (b) Photograph of the cut surface of the tumor shows a glistening appearance. (c) Photomicrograph (original magnification, x2; hematoxylin-eosin stain) shows adenocarcinoma involving the bladder wall with large lakes of mucin (arrows). The bladder mucosa (arrowhead) is normal.
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Figure 21b. Urachal adenocarcinoma. (a) Axial CT image shows a large, predominantly solid, midline mass with peripheral calcifications (arrowheads). Within the mass are scattered low-attenuation areas (arrows), which represent mucin. (b) Photograph of the cut surface of the tumor shows a glistening appearance. (c) Photomicrograph (original magnification, x2; hematoxylin-eosin stain) shows adenocarcinoma involving the bladder wall with large lakes of mucin (arrows). The bladder mucosa (arrowhead) is normal.
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Figure 21c. Urachal adenocarcinoma. (a) Axial CT image shows a large, predominantly solid, midline mass with peripheral calcifications (arrowheads). Within the mass are scattered low-attenuation areas (arrows), which represent mucin. (b) Photograph of the cut surface of the tumor shows a glistening appearance. (c) Photomicrograph (original magnification, x2; hematoxylin-eosin stain) shows adenocarcinoma involving the bladder wall with large lakes of mucin (arrows). The bladder mucosa (arrowhead) is normal.
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Figure 22a. Pseudomyxoma peritonei from urachal carcinoma. (a) Axial CT image shows a low-attenuation mass (arrow) involving the dome of the bladder. (b) Axial CT image of the midabdomen shows low-attenuation material and soft-tissue masses (arrows) within the peritoneal cavity. The bowel is displaced and is not free floating, as it would be in simple ascites. * = top of the bladder mass.
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Figure 22b. Pseudomyxoma peritonei from urachal carcinoma. (a) Axial CT image shows a low-attenuation mass (arrow) involving the dome of the bladder. (b) Axial CT image of the midabdomen shows low-attenuation material and soft-tissue masses (arrows) within the peritoneal cavity. The bowel is displaced and is not free floating, as it would be in simple ascites. * = top of the bladder mass.
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Figure 23. Small cell carcinoma. Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows small, round cells with scant cytoplasm infiltrating the muscularis mucosa in sheets and linear cords (arrow).
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Figure 24a. Small cell carcinoma. (a) Axial CT image shows a mass (arrows) in the bladder wall. (b) Axial CT image obtained 2 weeks later shows a rapid increase in the size of the mass (arrows).
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Figure 24b. Small cell carcinoma. (a) Axial CT image shows a mass (arrows) in the bladder wall. (b) Axial CT image obtained 2 weeks later shows a rapid increase in the size of the mass (arrows).
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Figure 25a. Small cell carcinoma. (a) Axial CT image, obtained in a patient with small cell carcinoma of the bladder, shows a soft-tissue mass that fills the pelvis and surrounds the uterus (arrow). Note the scalloping of the posterior uterine wall (arrowheads). (b) Axial CT image of the midabdomen shows metastases in the omentum (arrow) and mesentery (*). (c) Photograph of the uterus bivalved in the coronal plane shows the surrounding tumor (arrowheads) with invasion into the endometrium (arrows). An incidental fibroid (*) is also seen.
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Figure 25b. Small cell carcinoma. (a) Axial CT image, obtained in a patient with small cell carcinoma of the bladder, shows a soft-tissue mass that fills the pelvis and surrounds the uterus (arrow). Note the scalloping of the posterior uterine wall (arrowheads). (b) Axial CT image of the midabdomen shows metastases in the omentum (arrow) and mesentery (*). (c) Photograph of the uterus bivalved in the coronal plane shows the surrounding tumor (arrowheads) with invasion into the endometrium (arrows). An incidental fibroid (*) is also seen.
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Figure 25c. Small cell carcinoma. (a) Axial CT image, obtained in a patient with small cell carcinoma of the bladder, shows a soft-tissue mass that fills the pelvis and surrounds the uterus (arrow). Note the scalloping of the posterior uterine wall (arrowheads). (b) Axial CT image of the midabdomen shows metastases in the omentum (arrow) and mesentery (*). (c) Photograph of the uterus bivalved in the coronal plane shows the surrounding tumor (arrowheads) with invasion into the endometrium (arrows). An incidental fibroid (*) is also seen.
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Figure 26a. Carcinoid. (a) Anteroposterior radiograph obtained during intravenous urography shows a polypoid filling defect (arrow) in the bladder. (b) Axial CT image shows the solid, polypoid, enhancing mass (arrow). The imaging characteristics are nonspecific.
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Figure 26b. Carcinoid. (a) Anteroposterior radiograph obtained during intravenous urography shows a polypoid filling defect (arrow) in the bladder. (b) Axial CT image shows the solid, polypoid, enhancing mass (arrow). The imaging characteristics are nonspecific.
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Figure 27a. Leiomyoma. Sagittal T1-weighted (a) and T2-weighted (b) MR images of the bladder show a smooth, low-signal-intensity, intramural mass (arrows), an appearance typical of a leiomyoma.
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Figure 27b. Leiomyoma. Sagittal T1-weighted (a) and T2-weighted (b) MR images of the bladder show a smooth, low-signal-intensity, intramural mass (arrows), an appearance typical of a leiomyoma.
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Figure 28a. Degenerated leiomyoma. (a) Axial T2-weighted MR image shows an intramural mass within the lateral bladder wall. The mass is well defined with a low-signal-intensity rim and a high-signal-intensity center (*). (b) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows lack of enhancement in the central portion of the mass. Histologic analysis demonstrated a benign degenerated leiomyoma.
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Figure 28b. Degenerated leiomyoma. (a) Axial T2-weighted MR image shows an intramural mass within the lateral bladder wall. The mass is well defined with a low-signal-intensity rim and a high-signal-intensity center (*). (b) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows lack of enhancement in the central portion of the mass. Histologic analysis demonstrated a benign degenerated leiomyoma.
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Figure 29a. Leiomyosarcoma. (a) Axial T2-weighted MR image shows a large, heterogeneous mass within the bladder wall. (b) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows irregular enhancement of the mass. The adjacent bladder wall (arrow) is also abnormal and was found to be infiltrated by the tumor.
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Figure 29b. Leiomyosarcoma. (a) Axial T2-weighted MR image shows a large, heterogeneous mass within the bladder wall. (b) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows irregular enhancement of the mass. The adjacent bladder wall (arrow) is also abnormal and was found to be infiltrated by the tumor.
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Figure 30. Sarcoma botryoides. Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows the typical polypoid projections of tumor tissue into the bladder lumen. Note the cellular zone (cambium layer) (arrowheads) underneath the urothelial lining.
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Figure 31a. Botryoid rhabdomyosarcoma. (a) Anteroposterior radiograph obtained during intravenous urography shows multiple nodular filling defects arising from the base of the bladder. (b) Photograph of the cystectomy specimen shows several tumor nodules (arrows) along the posterior wall.
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Figure 31b. Botryoid rhabdomyosarcoma. (a) Anteroposterior radiograph obtained during intravenous urography shows multiple nodular filling defects arising from the base of the bladder. (b) Photograph of the cystectomy specimen shows several tumor nodules (arrows) along the posterior wall.
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Figure 32a. Botryoid rhabdomyosarcoma. (a, b) Transverse US (a) and axial CT (b) images show a grapelike mass filling the bladder lumen. (c) Photograph of the cut surface of the gross specimen shows the typical grayish, glistening, gelatinous appearance of the tumors.
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Figure 32b. Botryoid rhabdomyosarcoma. (a, b) Transverse US (a) and axial CT (b) images show a grapelike mass filling the bladder lumen. (c) Photograph of the cut surface of the gross specimen shows the typical grayish, glistening, gelatinous appearance of the tumors.
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Figure 32c. Botryoid rhabdomyosarcoma. (a, b) Transverse US (a) and axial CT (b) images show a grapelike mass filling the bladder lumen. (c) Photograph of the cut surface of the gross specimen shows the typical grayish, glistening, gelatinous appearance of the tumors.
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Figure 33. Invasive rhabdomyosarcoma. Axial gadolinium-enhanced fat-suppressed T1-weighted MR image of the bladder shows a tumor with significant extravesical extension (arrows).
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Figure 34a. Plexiform neurofibroma in a patient with known neurofibromatosis type 1. (a) Axial CT image shows low-attenuation, nodular thickening of the left lateral and posterior bladder walls. (b) Photograph of the cut surface of the resected bladder shows multiple fleshy nodules within the bladder wall.
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Figure 34b. Plexiform neurofibroma in a patient with known neurofibromatosis type 1. (a) Axial CT image shows low-attenuation, nodular thickening of the left lateral and posterior bladder walls. (b) Photograph of the cut surface of the resected bladder shows multiple fleshy nodules within the bladder wall.
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Figure 35. Plexiform neurofibroma. Sagittal T2-weighted MR image shows nodular thickening of the posterior bladder wall. Several nodules have a low-signal-intensity center surrounded by a high-signal-intensity rim (the target sign) (arrows). This sign is highly suggestive of a plexiform neurofibroma.
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Figure 36. Paraganglioma. Photomicrograph (original magnification, x60; hematoxylin-eosin stain) shows blood vessels compartmentalizing eosinophilic tumor cells into groups (zellballen).
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Figure 37. Paraganglioma. Axial CT image of the bladder shows dense ring calcification (arrows) around the circumference of a paraganglioma.
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Figure 38a. Paraganglioma. (a) Sagittal T1-weighted MR image shows a low-signal-intensity submucosal mass (arrows) within the anterior bladder wall. (b) Coronal T2-weighted MR image shows moderately high heterogeneous signal intensity in the mass (arrow).
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Figure 38b. Paraganglioma. (a) Sagittal T1-weighted MR image shows a low-signal-intensity submucosal mass (arrows) within the anterior bladder wall. (b) Coronal T2-weighted MR image shows moderately high heterogeneous signal intensity in the mass (arrow).
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Figure 39a. Paraganglioma. (a) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows a large bladder mass with significant extravesical extension. This appearance is nonspecific and may be seen with many tumors. (b) Frontal 131I-MIBG scan shows uptake in the mass (arrowhead), a finding that is highly specific for a paraganglioma.
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Figure 39b. Paraganglioma. (a) Axial gadolinium-enhanced fat-suppressed T1-weighted MR image shows a large bladder mass with significant extravesical extension. This appearance is nonspecific and may be seen with many tumors. (b) Frontal 131I-MIBG scan shows uptake in the mass (arrowhead), a finding that is highly specific for a paraganglioma.
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Figure 40a. B-cell lymphoma. (a) Longitudinal US image shows intraluminal bladder masses (white arrows) involving the posterior wall and ureteral orifice. The latter mass is causing obstruction in the form of a hydroureter (black arrows). (b) Axial CT image shows the thickening at the ureteral orifice (arrows). (c) Cystoscopic image of the right ureteral orifice shows the lobular nature of the mass. (d) Photomicrograph (original magnification, x150; hematoxylin-eosin stain) shows sheets of tumor cells with large nuclei and little cytoplasm.
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Figure 40b. B-cell lymphoma. (a) Longitudinal US image shows intraluminal bladder masses (white arrows) involving the posterior wall and ureteral orifice. The latter mass is causing obstruction in the form of a hydroureter (black arrows). (b) Axial CT image shows the thickening at the ureteral orifice (arrows). (c) Cystoscopic image of the right ureteral orifice shows the lobular nature of the mass. (d) Photomicrograph (original magnification, x150; hematoxylin-eosin stain) shows sheets of tumor cells with large nuclei and little cytoplasm.
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Figure 40c. B-cell lymphoma. (a) Longitudinal US image shows intraluminal bladder masses (white arrows) involving the posterior wall and ureteral orifice. The latter mass is causing obstruction in the form of a hydroureter (black arrows). (b) Axial CT image shows the thickening at the ureteral orifice (arrows). (c) Cystoscopic image of the right ureteral orifice shows the lobular nature of the mass. (d) Photomicrograph (original magnification, x150; hematoxylin-eosin stain) shows sheets of tumor cells with large nuclei and little cytoplasm.
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Figure 40d. B-cell lymphoma. (a) Longitudinal US image shows intraluminal bladder masses (white arrows) involving the posterior wall and ureteral orifice. The latter mass is causing obstruction in the form of a hydroureter (black arrows). (b) Axial CT image shows the thickening at the ureteral orifice (arrows). (c) Cystoscopic image of the right ureteral orifice shows the lobular nature of the mass. (d) Photomicrograph (original magnification, x150; hematoxylin-eosin stain) shows sheets of tumor cells with large nuclei and little cytoplasm.
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Figure 41. Hemangioma. Axial CT image shows an intramural bladder mass (arrow) with marked enhancement.
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Figure 42a. Solitary fibrous tumor. (a) Sagittal T2-weighted MR image shows obliteration of the bladder lumen by a large, predominantly low-signal-intensity mass (arrow) with scattered curvilinear areas of high signal intensity. (b) Photograph of the cut surface of the resected mass shows a solid, tan, fibrotic lesion, an appearance typical of solitary fibrous tumors.
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Figure 42b. Solitary fibrous tumor. (a) Sagittal T2-weighted MR image shows obliteration of the bladder lumen by a large, predominantly low-signal-intensity mass (arrow) with scattered curvilinear areas of high signal intensity. (b) Photograph of the cut surface of the resected mass shows a solid, tan, fibrotic lesion, an appearance typical of solitary fibrous tumors.
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Copyright © 2006 by the Radiological Society of North America.
