Clinical Quiz 0811-2
A 45-year-old otherwise healthy male presented to an emergency department with urinary retention. Gross hematuria was demonstrated upon insertion of a Foley catheter. Upon questioning, the man reported that he had intermittent gross hematuria for at least four years. Cross-sectional imaging demonstrated multifocal large tumors filling nearly the entire bladder lumen, with findings confirmed by cystoscopic examination.
Submit your diagnosis to see full explanation.
The answer is appropriate staging with transurethral resection. Despite worrisome imaging findings and extremely large tumor burden, this young patient was found to have low-grade Ta urothelial carcinoma. Upper tract and chest imaging were negative. He was rendered free of disease with aggressive TURBT in two separate sittings.
Random bladder biopsies 4 months thereafter demonstrated no evidence of residual carcinoma. This case underscores the rather indolent biology of low grade Ta urothelial cancer in this patient, who shied from medical attention for more than four years since experiencing his first episode of gross hematuria. Given his young age, large tumor size, and multifocal tumor burden, extremely close surveillance will be required.1
The case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
1. Morgan, T. M., Clark, P. E.: Bladder cancer. Curr Opin Oncol. 2010; 22: 242.