A case of inguinal bladder hernia]

Pyelocystography on a 61-year-old man with a ureteral stone incidentally revealed the inguinal bladder hernia. He had no complaint of urinary disturbances. During the operation for the hernia, we could not find the bladder without transurethral saline instillation; only the intestine covered with peritoneum was in sight. Utility of preoperative cystography on the cases of inguinal hernia is discussed.     

A case of scrotal bladder hernia containing bladder cancer]

A 70-year-old man had a history of total laryngectomy for laryngeal cancer and bilateral inguinal hernia repair 5 years previously. The patient had suffered from difficulty with urination since then and had been treated for prostatic hypertrophy at our department. He developed microscopic hematuria from June 1991, and was admitted because a bladder tumor was detected by cystoscopy. Cystography showed a scrotal bladder hernia with filling defects in the bladder per se and the bladder hernia as well. Cystoscopy revealed tumors in the hernia and in the vicinity of the ureteral orifice. Biopsy indicated transitional cell carcinoma. Voiding cystourethrography showed normal urination and no residual urine. Excision of the tumor-containing hernia, partial cystectomy with right ureteral orifice, and reconstruction of the right inguinal canal were performed on October 25, 1991. The postoperative course was favorable and he was discharged on the 40th postoperative day. The tumors were respectively stage as TCC, G1, and pT1a, and TCC, G1 greater than G2, and pT1b. Thirty five cases of bladder hernia that have been reported in Japan. Eight cases of accompanied by cancer have been reported in Japanese (3 cases) and foreign (5 cases) literatures. These are reviewed and discussed.     

A case of paraganglioma of the urinary bladder]

A 50-year-old male was referred to our department because of dysuria. On cystoscopy, a submucosal bladder tumor was seen at the posterior wall of the urinary bladder. Transurethral resection was performed with no intraoperative complications. Histopathological diagnosis of paraganglioma was confirmed by immunohistochemical staining.     

A case of malignant pheochromocytoma of the urinary bladder]

A 31-year-old man was admitted to our hospital because of miction pain and gross hematuria in August, 1988. Cystoscopic examination revealed a solid mass in the bladder. The histological diagnosis was pheochromocytoma of urinary bladder by biopsy. He had a history of syncope on urination several times. Abnormal elevation of serum noradrenaline was observed in hormonal studies and abnormal accumulation was seen in the bladder by 131I-MIBG scintigraphy. Total cystectomy, lymphadenectomy and urinary diversion were performed in November, 1988. Pathological diagnosis was pheochromocytoma of the urinary bladder with metastasis to both iliac lymph nodes.     

A case of submucosal endosalpingiosis in the urinary bladder]

A 47-year-old woman was admitted when a mass in the urinary bladder was pointed out on ultrasound follow-up after hysterectomy for uterine myoma. Cystoscopy, ultrasonography, CT scan and MRI suggested a tumor in the muscle layers of the urinary bladder. Since the possibility of malignancy could not be ruled out, partial cystectomy was performed. The tumor was diagnosed as endosalpingiosis, a subclassification of mullerianosis histologically. The concept of endosalpingiosis has appeared recently and only 3 cases have been reported none of who had severe symptoms. Our case is the forth in the world. One of these cases had been treated with hormonal therapy as endometriosis, with no effect. Therefore, surgery is recommended as the first treatment of choice.     

A case of malakoplakia of the kidney and urinary bladder]

A case of malakoplakia which co-existed in the kidney and the urinary bladder is reported. The patient was a 51-year-old female who had been suffering from asymptomatic macroscopic hematuria. Cystoscopic examination revealed multiple yellow-red nodules in the posterior and lateral wall of the bladder. Transurethral punch biopsy of the mucosa was performed and histopathological examination of the specimens revealed the diagnosis of malakoplakia. The laboratory data at admission were within normal limits except for slightly accelerated erythrocyte sedimentation rate. The culture of urine was negative. The cytology of urine was interpreted as Papanicolaou class I. Intravenous pyelography demonstrated filling defect of the left upper renal calyx, which was confirmed by retrograde pyelography. Computerized tomography showed dilatation of the left upper calyx. An exploratory operation disclosed that the upper calyceal neck was obstructed by several small nodular lesion, which were very similar to the lesions in the bladder. Because intraoperative pathological diagnosis of the frozen section was malakoplakia, partial nephrectomy was performed. Histopathological examination of the kidney and the bladder showed typical Michaelis-Gutmann bodies in the granulomatous lesions. Follow-up examinations 4 months after operation revealed some residual lesions in the bladder which were treated with bethanechol, but no recurrence in the kidney.     

A case of metastatic urinary bladder tumor from gastric carcinoma]

We report a case of metastatic bladder tumor from gastric carcinoma. A 55-year old male patient was referred to our urological clinic with a complaint of frequent urination and voiding pain. He had undergone total gastrectomy for poorly differentiated adenocarcinoma, signet-ring cell type, 9 months earlier. Computed tomographic scan revealed a thick bladder and rectum wall all around. Punch biopsies from vesical and rectal wall revealed metastatic adenocarcinoma, signet-ring cell type. There were no other metastatic sites. Systemic chemotherapy was done with a combination of mitomycin-C, 5-fluorouracil and cytosine arabinoside. This chemotherapy was effective and complete remission was obtained at bladder and rectum. Six months after chemotherapy, peritoneal recurrence developed and he died 9 months after chemotherapy. However no recurrence of bladder tumor was detected. This was a quite rare case of metastatic bladder tumor characterized by good response to systemic chemotherapy.     

Small cell carcinoma of urinary bladder. A case report]

A 57-year-old male patient was admitted because of a severe lumbar pain and gross hematuria. The rectal examination revealed a fist-sized soft tissue mass in the small pelvic space. A huge non-papillary tumor, which occupied the intravesical space, was found on cystoscopic examination. CEA IAP, TPA, CA19-9 and NSE were abnormally elevated in the serum. The pelvic CT scan shown an enormous polypoid tumor arising from the anterior vesical wall, while no abnormal lesion was found in the head, neck, chest and abdominal CT scans. The bone scintigraphy revealed multiple abnormal accumulations. The transurethral biopsy of the tumor was carried out. The pathological examination revealed homogeneous and small tumor cells arranged in sheet and solid patterns, which were positive for the anti-NSE stain and anti-NF stain, but negative for Grimelius stain. The final diagnosis was small cell undifferentiated carcinoma of the urinary bladder. The patient died of cancer five months after diagnosis.     

Obturator hernia of urinary bladder.

A case demonstrating an obscure cause of backache is presented in which an obturator bladder hernia was diagnosed preoperatively and corrected surgically.     

A case of primary signet ring cell carcinoma in urinary bladder]

A case of primary signet ring cell carcinoma in the urinary bladder in a 50-year-old male is described. The patient with a complaint of urinary incontinence was admitted for invasive bladder carcinoma based on cystoscopic examination. The pathological specimen using transurethral resection-biopsy revealed signet ring cell carcinoma. In the preoperative work up, no obvious metastases were found. Following hospitalization, the patient's course gradually worsened with weight-loss, abdominal fullness and dysuria. The operation for total cystectomy was started, but was interrupted when the peritoneal cavity was found to be fully occupied with massive ascites, invasive lesions into nets and surrounding tissue. He died on November 19, 1986, approximately 7 months after onset of symptoms. An autopsy proved that the tumor which was pathologically identified as signet ring cell carcinoma, originated from the urinary bladder invading the perivesical tissues, and also into the intraabdominal space. We found 34 cases in the literature, originating from the urinary bladder. This case is considered to be the 35th. In conclusion, rapid total cystectomy following an early and definite diagnosis is the only procedure to treat such tumors.     

Massive incisional hernia of the bowel and urinary bladder: a case report

Abdominal hernias are not rare in women, but incisional bladder herniation is uncommon. Incisional hernias are an iatrogenic condition caused by protrusion of the abdominal viscera through the abdominal fascia. Omentum and small intestines are by far the most common viscera involved, and the condition is diagnosed on clinical examination either visually or by palpation of an abdominal bulge. We describe a case of bladder and bowel herniation through a lower transverse abdominal incision (Pfannenstiel), which followed emergent operative intervention for ectopic pregnancy.     

A case of carcinosarcoma of the urinary bladder

We report a case of carcinosarcoma of the urinary bladder. A 68-year-old man visited our hospital with complaints of asymptomatic macroscopic hematuria, cold sweat and general malaise. Excretory urography revealed a filling defect in the left wall of the bladder, and subsequent cystoscopy revealed a non-papillary sessile tumor. The tumor was transurethrally resected and its histology showed carcinosarcoma which was characteristics of a mixture of transitional cell carcinoma with spindle cell sarcoma. The patient underwent total cystectomy and his bladder was reconstructed with the ileum. Nevertheless, he died of multiple organ metastases 3 months after the surgery.     

A case of leiomyosarcoma of the urinary bladder

A case of leiomyosarcoma of the urinary bladder in a 33-year-old female is reported. She was admitted with the complaint of gross hematuria. Cystoscopic examination showed a thumb-tip sized mass, located at the dome. CT showed a wide-based tumor at the dome (CT number was 60.2 H.U.). Segmental resection of bladder was performed, followed by radiation and chemotherapy (VCR, ACT-D, CPM and ADM). She is alive without evidence of disease 13 months after surgery. A case report and review of the literature are presented.     

A case of pheochromocytoma of the urinary bladder

A case of pheochromocytoma of the urinary bladder is reported. A 17-year-old male was admitted to our hospital because of gross hematuria and urinary retention on Nov. 10, 1985. There was no history of hypertension. Intravenous pyelography and cystogram demonstrated a filling defect in the bladder. Transabdominal sonography disclosed a solid mass in the anterior wall and bladder neck. Cystoscopic examination revealed a non-papillary and broad based tumor in the anterior wall and bladder neck. Partial resection of the bladder wall was performed under the diagnosis of bladder tumor. The histological diagnosis was pheochromocytoma of the urinary bladder.     

A case of carcinosarcoma of the urinary bladder

We report a case of carcinosarcoma of the urinary bladder. A 50-year-old man visited our hospital with asymptomatic macroscopic hematuria as a chief complaint. Excretory urography revealed a filling defect in the right wall of the bladder, and subsequent cystoscopy revealed a non-papillary tumor above the right orifice. The patient underwent total cystectomy and had a neobladder constructed with the ileum (Hautmann's method). Microscopic examination showed a tumor composed of a mixture of transitional cell carcinoma and rhabdomyosarcoma. Immunohistochemical examination showed that the area of epithelium component was positive for cytokeratin and the non-epithelium area was positive for vimentin, there being no relationship between the two. The patient began complaining of coccyalgia 10 days after the operation. He died about 1 month after the operation because of the recurrence in the pelvic cavities.     

A case of carcinosarcoma of the urinary bladder

A 66-year-old woman visited our hospital complaining of painful, irritative urinary symptoms and macroscopic hematuria. Cystoscopy revealed a non-papillary tumor covered with necrotic tissue on the right side of the posterior wall of the bladder. Transurethral resection was performed ; histologically, the tumor was found to be composed of carcinomatous and sarcomatous elements. The carcinomatous element consisted of urothelial and squamous cell carcinomas. The sarcomatous element was composed of osteosarcoma, chondrosarcoma and spindle cell sarcoma. Immunohistochemical examination showed that the carcinomatous component was positive for cytokeratin and the sarcomatous component was positive for S-100 protein. The patient underwent total cystectomy with ileal conduit under the diagnosis of carcinosarcoma. Pathological examination showed no residual tumor. She was followed up with no signs of recurrence or metastasis. Computed tomography (CT) at nine months following surgery showed no evidence of recurrence. However, thirteen months after the operation, she complained of lower abdominal pain, and CT demonstrated a bulky intrapelvic tumor and right hydronephrosis. Her condition worsened rapidly and she died one month later.     

A case report of bladder hernia associated with prostate cancer

We report a case of bladder hernia. A 68-year-old man was admitted to our hospital for the management of prostate cancer. An egg-sized soft mass was palpated at his right inguinal region. Magnetic resonance imaging and cystography revealed that the mass was a bladder hernia. During radical prostatectomy, we had to resect the bladder hernia for safe regional lymphadenectomy. This hernia was the extraperitoneal type. The stage of prostate cancer was pT3b N0 M0. This is the third reported case of inguinal bladder hernia associated with prostate cancer in Japan.     

A Morgagni-Larrey hernia. A case report]

The paper reports a case of Morgagni-Larrey hernia observed by the authors. The etiopathogenesis is described and the importance of surgery is underlined even in asymptomatic cases in order to ensure a benign postoperative outcome.