Micropapillary carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture

Abstract

Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We describe an unusual case of a patient, admitted to emergency, with diffuse abdominal pain due to spontaneous bladder rupture in association with a micropapillary carcinoma. A diagnosis of an intraperitoneal bladder perforation was made during an emergency operation. Aspects of etiology, clinical presentation, diagnosis and management are described. Although cases of spontaneous carcinomatous bladder rupture are associated with high morbidity and mortality, prompt identification and treatment can lead to favourable outcomes.

Fig. 1.

Ultrasound of the pelvis shows distended bladder with calcified filling defects of about 28 mm on the dome.

Fig. 2.

Macroscopic appearance of the resected urinary bladder wall: tissue sample of irregular shape, size 110 × 65 mm, with perforation of the wall (3 mm in diameter, white arrow) and with discrete proliferation of the tumour (black arrows).

Fig. 3.

Invasive micropapillary carcinoma: a) microscopic view of the bladder wall with tumour localized in the superficial part and extended to muscle (hematoxylin–eosin stain, original magnification, × 40); b) cytological features of invasive micropapillary carcinoma: tumour cells showing moderate amounts of cytoplasm, vesicular nuclei and markedly uneven coarse chromatin (hematoxylin–eosin stain, original magnification, × 400).

Fig. 4.

A computed tomography scan of the bladder shows reduced bladder capacity with bladder muscle thickening, the most pronounced in the area of the vault, no clear sign of tumour recurrence, enlarged benign prostatic hyperplasia, and also without lymph node metastases in the pelvic cavity.