Presentation
Gross hematuria. Known case of multiple myeloma.
Patient Data
Mildly thickened posterior urinary bladder wall. Two immobile polypoidal lesions are also seen attached to the posterior urinary bladder wall. Mild vascularity is seen in these polypoidal lesions. Foley's catheter is seen in place.
a few polypoidal lesions in the urinary bladder with the largest lesion seen along the base of the urinary bladder. No extravesical extension is seen. No suspicious mass lesion is seen in the kidneys and ureters.
multiple variable size simple cortical cysts in both kidneys. No radiopaque renal/ureteric calculi or hydroureteronephrosis is seen.
compression fractures of the T12 and L1 vertebral bodies. Heterogeneous bone density and innumerable lytic lesions noted in the visualized skeleton. A few sections through the lung bases show mild bilateral basal atelectatic changes.
no lymphadenopathy is seen.
Magnified images of the pelvis during the renal excretory phase showing a few polypoidal lesions in the urinary bladder with the largest lesion seen along the base of the urinary bladder.
Cystoscopy and histopathology
Cystoscopy showed multiple hemorrhagic lesions in the posterior bladder wall, dome and bladder neck. Histopathology of the TURBT specimen showed invasive urothelial carcinoma with squamous differentiation.
Bone marrow biopsy findings consistent with multiple myeloma.
Case Discussion
A few polypoidal lesions in the urinary bladder with the largest lesion seen along the base of the urinary bladder. Histopathology of the TURBT specimen showing invasive urothelial carcinoma with squamous differentiation.
Multiple bone lesions and compression fractures of the T12 and L1 vertebrae are likely related to the past history of multiple myeloma; other possible differential is bone metastases, which is however unlikely because of the bone marrow findings.
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