- Email: [email protected]
Calcification of bladder tumor
CALCIFICATION LT. COL.
ROBERT
OF BLADDER
D. BIGGERS,
TUMOR
(MC) USAF
From the Department of Urology, USAF Academy Hospital, U.S. Air Force Academy, Colorado Springs, Colorado
ABSTRACT-A bladder cancer presented as a calcified pelvic mass on roentgenograms. quency and significance of calcified bladder tumors is discussed.
A fifty-year-old male jogger presented with the complaint of gross hematuria after running more than three miles. He denied any prior urinary problems, any family history of urinary disease, any urinary symptoms other than the hematuria, and any flank pain, fever, or nausea. The urine was grossly clear at the time of presentation, but did contain microscopic amounts of erythrocytes and was sterile. An excretory urogram was obtained, and a calcified mass was present on x-ray film (kidney-ureterbladder) (Fig. 1). Subsequent films showed the mass to lie within the bladder. Cystoscopic evaluation revealed a papillary growth on the left lateral wall of the bladder covered with encrustations. It was subsequently resected transurethrally and found to be an invasive, poorly differentiated transitional cell carcinoma. The patient underwent cystoprostatectomy and has recovered uneventfully. In the year following surgery there has been no evidence of persistent or recurrent disease. Comment While gross hematuria is a common presenting symptom for bladder cancer, calcification is an unusual radiologic sign, Emmett and Witten’ state that urinary salts may be deposited on almost any type of tumor, Braband found an incidence of only 0.69 per cent in a review of 1,000 cases of bladder tumors. A review of the recent literature revealed only 3 reported cases of calcified transitional cell carcinoma with no mention of the grade of the lesion in 2 of the 3 cases.3-5 The views expressed herein are those of the authors and do not necessarily reflect the views of the United States Air Force.
656
FIGURE1. Plain film of abdomen larly calcified mass in left pelvis.
The fre-
revealing irregu-
Histologic examination of the tumor in our case showed that the calcification was a deposition of calcium salts on the outer surface of the papillary growth. Further examination showed areas of infarction and necrosis. The unusual encrustation is most likely related to the extremely malignant nature of the neoplasm with resultant infarction, necrosis, and calcification. The serendipitous occurrence of gross hematuria proved to hasten the diagnosis and thus improved the prognosis. Colorado Springs, Colorado 80840 (DR. BIGGERS) References 1. Emmett JL, and Witten DM: Clinical Urography, 4th ed, Philadelphia, WB Saunders Co, 1977, p 1630. 2. Braband H: Incidence of urographic findings in tumours of urinary bladder, Br J Radio1 34: 625 (1961). 3. Davidson HD, Witten DM, and Culp OS: Roentgenographically demonstrable calcification in tumors of the bladder, Am J Radio1 Radium Ther Nucl Med 95: 450 (1965). 4. O’Cleireachain F, Awad SA, and Prentice RSA: Gross calcification in bladder tumor, Urology 3: 642 (1974). 5. Berg RA, and Chan YS: Diagnosis of bladder cancer on intravenous pyelography, ibid 1: 230 (1973).
UROLOGY
/
JUNE 1985
/
VOLUME XXV, NUMBER 6
ROBERT
OF BLADDER
D. BIGGERS,
TUMOR
(MC) USAF
From the Department of Urology, USAF Academy Hospital, U.S. Air Force Academy, Colorado Springs, Colorado
ABSTRACT-A bladder cancer presented as a calcified pelvic mass on roentgenograms. quency and significance of calcified bladder tumors is discussed.
A fifty-year-old male jogger presented with the complaint of gross hematuria after running more than three miles. He denied any prior urinary problems, any family history of urinary disease, any urinary symptoms other than the hematuria, and any flank pain, fever, or nausea. The urine was grossly clear at the time of presentation, but did contain microscopic amounts of erythrocytes and was sterile. An excretory urogram was obtained, and a calcified mass was present on x-ray film (kidney-ureterbladder) (Fig. 1). Subsequent films showed the mass to lie within the bladder. Cystoscopic evaluation revealed a papillary growth on the left lateral wall of the bladder covered with encrustations. It was subsequently resected transurethrally and found to be an invasive, poorly differentiated transitional cell carcinoma. The patient underwent cystoprostatectomy and has recovered uneventfully. In the year following surgery there has been no evidence of persistent or recurrent disease. Comment While gross hematuria is a common presenting symptom for bladder cancer, calcification is an unusual radiologic sign, Emmett and Witten’ state that urinary salts may be deposited on almost any type of tumor, Braband found an incidence of only 0.69 per cent in a review of 1,000 cases of bladder tumors. A review of the recent literature revealed only 3 reported cases of calcified transitional cell carcinoma with no mention of the grade of the lesion in 2 of the 3 cases.3-5 The views expressed herein are those of the authors and do not necessarily reflect the views of the United States Air Force.
656
FIGURE1. Plain film of abdomen larly calcified mass in left pelvis.
The fre-
revealing irregu-
Histologic examination of the tumor in our case showed that the calcification was a deposition of calcium salts on the outer surface of the papillary growth. Further examination showed areas of infarction and necrosis. The unusual encrustation is most likely related to the extremely malignant nature of the neoplasm with resultant infarction, necrosis, and calcification. The serendipitous occurrence of gross hematuria proved to hasten the diagnosis and thus improved the prognosis. Colorado Springs, Colorado 80840 (DR. BIGGERS) References 1. Emmett JL, and Witten DM: Clinical Urography, 4th ed, Philadelphia, WB Saunders Co, 1977, p 1630. 2. Braband H: Incidence of urographic findings in tumours of urinary bladder, Br J Radio1 34: 625 (1961). 3. Davidson HD, Witten DM, and Culp OS: Roentgenographically demonstrable calcification in tumors of the bladder, Am J Radio1 Radium Ther Nucl Med 95: 450 (1965). 4. O’Cleireachain F, Awad SA, and Prentice RSA: Gross calcification in bladder tumor, Urology 3: 642 (1974). 5. Berg RA, and Chan YS: Diagnosis of bladder cancer on intravenous pyelography, ibid 1: 230 (1973).
UROLOGY
/
JUNE 1985
/
VOLUME XXV, NUMBER 6