25369 CARCINOMA OF THE BLADDER WITH DIVERTICULA, HYPERPLASIA OF PROSTATE, BILATERAL HYDRONEPHROSIS
The patient was a man aged 75 who presented with urinary retention and overflow for 2 weeks, together with massive haematuria. The abdomen was tense the liver was enlarged, and a mass could be felt in the right iliac fossa. Per rectum the right lobe of the prostate felt hard. Cystoscopy showed a greatly trabeculated bladder and the right lateral wall and base and the left lower wall were infiltrated by irregular bleeding tumour tissue. He died 3 weeks later.
The specimen consists of the bladder, prostate, ureters and kidneys viewed from behind. A large fungating carcinoma is present on the right side of the bladder extending slightly to the posterior wall.
The tumour has invaded through the full thickness of the bladder wall and measures 3 cms at its thickest point. The inner surface of the tumour is irregularly nodular, friable and haemorrhagic. The bladder is contracted and trabeculated and its muscle coat is hypertrophied. A very large bilocular diverticulum arises posterior to the entrance of the prostatic urethra by an opening measuring about 4 x 2.5 cms. A large loculus of this diverticulum 7 cms in diameter projects to the left, and a smaller loculus 2.5 cms in diameter projects posteriorly. The left ureter runs over the anterior surface of the left loculus. The left kidney is enlarged to 16 cms and shows marked intrarenal and extrarenal hydronephrosis. Some small cavities near the centre contain pale exudate, probably pus. The left ureter is considerably dilated. The right ureter is not obviously dilated but the right kidney shows intrarenal and extrarenal hydronephrosis of a more extreme degree than is present in the left kidney, so that almost no renal substance survives. The reverse of the specimen shows a rounded adenoma 2 cms in diameter at the upper pole of the left kidney. The prostate is enlarged and measures 5 cms in diameter. Adenomatous hyperplasia is evident in the centre of the organ surrounded by a compressed shell of infected prostatic tissue. The prostatic urethra is compressed laterally but runs directly in the midline. Histology shows a somewhat anaplastic transitional-cell carcinoma of the bladder. Mitotic figures are quite numerous. The carcinoma extends also beneath the capsule of the prostate. The central parts of the prostate are hyperplastic.
