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Small cell carcinoma of the urinary bladder: CT and MR imaging findings.

Kim JC, Kim KH, Jung S - Korean J Radiol (2003 Apr-Jun)

Bottom Line: On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass.It was stage C or higher, and lymph nodes and distant metastasis were frequent.When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Chungnam National University School of Medicine, Daejeon, Korea. jckim@cnuh.co.kr

ABSTRACT

Objective: Primary small cell carcinoma (SCC) is a rare aggressive malignancy of the urinary bladder, with identical histopathology to that of the lung. The treatment and prognosis of bladder SCC are somewhat different from those of more frequent transitional cell carcinoma. The purpose of this study was to analyze the CT and MR imaging findings of bladder SCC.

Materials and methods: Six adult patients (five males and one female) with pathologically proven SCC of the urinary bladder who had undergone pelvic CT and/or MR imaging were included in this study. The radiologic findings were retrospectively evaluated in terms of tumor location, texture, calcification, depth of invasion, perivesical extension, lymph node involvement, and local or distant metastasis, by two radiologists, who established a consensus.

Results: CT and MR images depicted all tumors as large, ill-defined, relatively well enhancing, broad-based polypoid intramural masses with (n=3) or without (n=3) cystic portions. Their frequent location was posterior and trigonal (n=3). Calcification was found within one tumor, and lymphadenopathy in four. At T2-weighted MR images, the solid portion of the tumor was relatively hypointense. The stage at the time of diagnosis was C in three patients, and D1 in three. Follow-up imaging showed brain metastasis in one patient and liver metastasis in two.

Conclusion: On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass. It was stage C or higher, and lymph nodes and distant metastasis were frequent. T2-weighted MR images showed that the solid portion of the tumor was relatively hypointense. When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.

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A 59-year-old female with stage D1 SCC of the urinary bladder (Case 6).A, B. Pre-contrast (A) and post-contrast (B) pelvic CT reveals a heterogeneously enhancing irregular mass in and beyond the posterior wall of the urinary bladder. At the anterior aspect of the mass, there is calcification (arrowhead). Note the exophytic posterior portion of the tumor beyond the bladder wall (arrow), and left pelvic lymphadenopathy (n).C-E. Axial T1-weighted (C), T2-weighted (D), and post-contrast T1-weighted (E) pelvic MR images reveal that the tumor, which invades the anterior vaginal wall (v) and pelvic lymph nodes (n), has both enhancing solid portions and non-enhancing cystic or necrotic portions. A Foley catheter (f) is seen within the bladder. The T2-weighted image shows that the peripheral solid portions of the tumor (arrows) are relatively hypo- or isointense compared with the anterior bladder wall.
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Figure 3: A 59-year-old female with stage D1 SCC of the urinary bladder (Case 6).A, B. Pre-contrast (A) and post-contrast (B) pelvic CT reveals a heterogeneously enhancing irregular mass in and beyond the posterior wall of the urinary bladder. At the anterior aspect of the mass, there is calcification (arrowhead). Note the exophytic posterior portion of the tumor beyond the bladder wall (arrow), and left pelvic lymphadenopathy (n).C-E. Axial T1-weighted (C), T2-weighted (D), and post-contrast T1-weighted (E) pelvic MR images reveal that the tumor, which invades the anterior vaginal wall (v) and pelvic lymph nodes (n), has both enhancing solid portions and non-enhancing cystic or necrotic portions. A Foley catheter (f) is seen within the bladder. The T2-weighted image shows that the peripheral solid portions of the tumor (arrows) are relatively hypo- or isointense compared with the anterior bladder wall.

Mentions: At CT and MR imaging, all six tumors appeared as large, broad-based polypoid masses (Figs. 1-3). Their location within the urinary bladder was posterior and trigonal in three patients (Figs. 1 and 3), and anterior and trigonal (Fig. 2), anterior and right lateral, and anterior and left lateral, respectively, in the other three. The maximal diameter of the six tumors ranged from 3.0 to 8.2 (mean, 5.0) cm. All were enhanced at post-contrast CT [four were well enhanced (70-90 HU) and the other two were slightly enhanced (40-60 HU)] and at post-contrast MR imaging. Unenhanced cystic or necrotic portions, occupying less than one third of the whole tumor volume, were noted in three tumors (Figs. 2 and 3). Calcification within the tumor was found in one patient (Fig. 3). At the time of diagnosis, whole-layer muscular invasion with perivesical extension had occurred in all six cases (Figs. 1-3). Three tumors were Jewett-Strong-Marshall stage C (Fig. 2), and the other three were D1 (Figs. 1 and 3). Among the three patients with a tumor at this latter stage, there was involvement of both seminal vesicles and the left distal ureter in one male (Fig. 1), of the anterior vagina wall and both ureters in one female (Fig. 3), and of the right seminal vesicle in the other male. In two patients who underwent MR imaging studies, the signal intensity of the solid portions of the tumors was low at T1-weighted imaging and relatively low or similar to those of pelvic muscles at T2-weighted imaging (Fig. 3). Pelvic lymph node involvement was found in three patients at presentation (Figs. 2 and 3); and during follow-up, distant lymph node metastasis was noted in two patients, brain metastasis in one (Fig. 2), and liver metastasis in two. These three last-mentioned all expired within one year of initial diagnosis.


Small cell carcinoma of the urinary bladder: CT and MR imaging findings.

Kim JC, Kim KH, Jung S - Korean J Radiol (2003 Apr-Jun)

A 59-year-old female with stage D1 SCC of the urinary bladder (Case 6).A, B. Pre-contrast (A) and post-contrast (B) pelvic CT reveals a heterogeneously enhancing irregular mass in and beyond the posterior wall of the urinary bladder. At the anterior aspect of the mass, there is calcification (arrowhead). Note the exophytic posterior portion of the tumor beyond the bladder wall (arrow), and left pelvic lymphadenopathy (n).C-E. Axial T1-weighted (C), T2-weighted (D), and post-contrast T1-weighted (E) pelvic MR images reveal that the tumor, which invades the anterior vaginal wall (v) and pelvic lymph nodes (n), has both enhancing solid portions and non-enhancing cystic or necrotic portions. A Foley catheter (f) is seen within the bladder. The T2-weighted image shows that the peripheral solid portions of the tumor (arrows) are relatively hypo- or isointense compared with the anterior bladder wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 3: A 59-year-old female with stage D1 SCC of the urinary bladder (Case 6).A, B. Pre-contrast (A) and post-contrast (B) pelvic CT reveals a heterogeneously enhancing irregular mass in and beyond the posterior wall of the urinary bladder. At the anterior aspect of the mass, there is calcification (arrowhead). Note the exophytic posterior portion of the tumor beyond the bladder wall (arrow), and left pelvic lymphadenopathy (n).C-E. Axial T1-weighted (C), T2-weighted (D), and post-contrast T1-weighted (E) pelvic MR images reveal that the tumor, which invades the anterior vaginal wall (v) and pelvic lymph nodes (n), has both enhancing solid portions and non-enhancing cystic or necrotic portions. A Foley catheter (f) is seen within the bladder. The T2-weighted image shows that the peripheral solid portions of the tumor (arrows) are relatively hypo- or isointense compared with the anterior bladder wall.
Mentions: At CT and MR imaging, all six tumors appeared as large, broad-based polypoid masses (Figs. 1-3). Their location within the urinary bladder was posterior and trigonal in three patients (Figs. 1 and 3), and anterior and trigonal (Fig. 2), anterior and right lateral, and anterior and left lateral, respectively, in the other three. The maximal diameter of the six tumors ranged from 3.0 to 8.2 (mean, 5.0) cm. All were enhanced at post-contrast CT [four were well enhanced (70-90 HU) and the other two were slightly enhanced (40-60 HU)] and at post-contrast MR imaging. Unenhanced cystic or necrotic portions, occupying less than one third of the whole tumor volume, were noted in three tumors (Figs. 2 and 3). Calcification within the tumor was found in one patient (Fig. 3). At the time of diagnosis, whole-layer muscular invasion with perivesical extension had occurred in all six cases (Figs. 1-3). Three tumors were Jewett-Strong-Marshall stage C (Fig. 2), and the other three were D1 (Figs. 1 and 3). Among the three patients with a tumor at this latter stage, there was involvement of both seminal vesicles and the left distal ureter in one male (Fig. 1), of the anterior vagina wall and both ureters in one female (Fig. 3), and of the right seminal vesicle in the other male. In two patients who underwent MR imaging studies, the signal intensity of the solid portions of the tumors was low at T1-weighted imaging and relatively low or similar to those of pelvic muscles at T2-weighted imaging (Fig. 3). Pelvic lymph node involvement was found in three patients at presentation (Figs. 2 and 3); and during follow-up, distant lymph node metastasis was noted in two patients, brain metastasis in one (Fig. 2), and liver metastasis in two. These three last-mentioned all expired within one year of initial diagnosis.

Bottom Line: On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass.It was stage C or higher, and lymph nodes and distant metastasis were frequent.When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Chungnam National University School of Medicine, Daejeon, Korea. jckim@cnuh.co.kr

ABSTRACT

Objective: Primary small cell carcinoma (SCC) is a rare aggressive malignancy of the urinary bladder, with identical histopathology to that of the lung. The treatment and prognosis of bladder SCC are somewhat different from those of more frequent transitional cell carcinoma. The purpose of this study was to analyze the CT and MR imaging findings of bladder SCC.

Materials and methods: Six adult patients (five males and one female) with pathologically proven SCC of the urinary bladder who had undergone pelvic CT and/or MR imaging were included in this study. The radiologic findings were retrospectively evaluated in terms of tumor location, texture, calcification, depth of invasion, perivesical extension, lymph node involvement, and local or distant metastasis, by two radiologists, who established a consensus.

Results: CT and MR images depicted all tumors as large, ill-defined, relatively well enhancing, broad-based polypoid intramural masses with (n=3) or without (n=3) cystic portions. Their frequent location was posterior and trigonal (n=3). Calcification was found within one tumor, and lymphadenopathy in four. At T2-weighted MR images, the solid portion of the tumor was relatively hypointense. The stage at the time of diagnosis was C in three patients, and D1 in three. Follow-up imaging showed brain metastasis in one patient and liver metastasis in two.

Conclusion: On CT and MR images, SCC of the urinary bladder appeared as a large, enhancing, broad-based polypoid mass. It was stage C or higher, and lymph nodes and distant metastasis were frequent. T2-weighted MR images showed that the solid portion of the tumor was relatively hypointense. When radiologic examinations demonstrate a bladder tumor of this kind in adults, SCC of the urinary bladder should be included in the differential diagnosis.

Show MeSH
Related in: MedlinePlus