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a
Figure 3.46
Massive tumor. (a) This was a transitional cell cancer of the
bladder. A study of the upper tracts (b) showed a further
transitional cell cancer in the kidney (arrowed).
b
Figure 3.47
Tumor obliterans. The tumor fills the bladder. Its relation to
the bladder is only seen by the position of the urinary catheter.
Figure 3.48
Encrusted tumor. The encrustation on the surface of the small
tumor causes shadowing. It resembles a calculus. It did not
move and has an irregular surface, making tumor more likely.
Tumor was confirmed by cystoscopy. (See also Figure 3.43 .)
Squamous cell cancer
prostatic carcinoma may mimic transitional cell carcinoma
( Figure 3.50 ). The central location of these prostatic lesions
usually helps distinguish them from the invasive bladder
cancer but it is often difficult to exclude a coexisting blad-
der cancer close to the prostate. In cases of doubt,
cystoscopy is indicated. Benign bladder wall trabeculation
may be confused with small neoplasms. Trabeculations
usually measure 1-3 mm in size and it is rare for small
polypoid transitional cell carcinoma of this size to be iden-
tified. Ultimately, cystoscopy with biopsy is necessary for
definitive diagnosis.
Squamous cell carcinoma of the bladder is unusual,
accounting for only 2% of all primary neoplasms of the
bladder in Western countries. It has been associated with
chronic inflammation of the bladder due to infection,
calculi or strictures, and it may arise in bladder diverticula
as a result of chronic inflammation. Neither racial nor
occupational associations are known. However, a 3:2 male
to female sex ratio has been described. Sonographically,
these neoplasms may have a similar appearance to
 
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