March's Case of the Month

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Odd-looking Bladder Mass with a Stalk

Emily Evans BVM&S

Patient information:

Age: 10 year old

Species: Canine

Gender: Male Neutered

Breed: Pit Bull
 

History: 


Patient had a 3 week history of stranguria, frequent urination and hematuria. Antibiotic therapy (Amoxicillin for 2 weeks) resulted in no improvements. A caudal abdominal mass was palpated on recheck exam.

Image interpretation: 


A  large (~4.0x3.6cm), round, heterogenous hypoechoic, vascular mass is seen occupying the bladder lumen with a thick hyperechoic wall(<0.3cm). A  vascular, hyperechoic stalk(~0.5cm thick) extended from the caudal aspect of the mass into the proximal urethra at the level of the prostate. The mass filled most of the partially full bladder but appeared non-obstructive. The remainder of the bladder had normal thickness, contour and there were no  uroliths seen. There was no evidence of structural change in the kidneys. The prostate had a normal size (1.1cm in diameter), shape and echogenicity.

Diagnosis and Sonographic Analysis: 


Tumors of the urinary bladder are uncommon in dogs. Transitional cell carcinoma (TCC) is the most common primary tumor of the urinary bladder.  Other differentials include squamous cell carcinoma, leiomyosarcoma, leiomyoma, and rhabdomyosarcoma or benign bladder polyp. The bladder may also be invaded by prostatic neoplasia or metastatic disease (e.g., hemangiosarcoma, lymphoma).

Discussion: 


Most TCCs have a more invasive appearance than the mass in this case, typically causing irregularity of the bladder wall in the trigone. TCCs are not limited to the bladder trigone and can begin anywhere in the bladder, urethra, kidneys and prostate.

Case Outcome: 


An oncology consultation was pursued and therapy was initiated for a presumed TCC. The patient was started on Piroxicam and Mitoxantrone along with a repeat course of antibiotics. He has showed continued improvement and the hematuria has fully resolved. He still has frequent urination but everyone is pleased with his progression. A recheck ultrasound is scheduled for later this month.

Sagittal view of large luminal bladder mass.

Sagittal view of large luminal bladder mass.

Solid stalk attaching mass to proximal urethra.

Solid stalk attaching mass to proximal urethra.

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Color flow doppler analysis showing vascular signal in both the mass and through the stalk.

Color flow doppler analysis showing vascular signal in both the mass and through the stalk.

Special thanks to Battlefield Veterinary Clinic of Sandston, VA and The Oncology Service at Dogwood Veterinary Emergency and Speciality Center.