Imaging in gynecological disease: clinical and ultrasound characteristics of urinary bladder malignancies

OBJECTIVES: To describe clinical and ultrasound characteristics of urinary bladder malignancies diagnosed on transvaginal ultrasound in women presenting with suspected gynecological problems. METHODS: This is a multicenter retrospective study of women with histological diagnosis of urinary bladder malignancy that was suspected on transvaginal ultrasound examination. The cases were collected from three centers which specialize in the use of pelvic ultrasound between January 2007 and October 2018. Clinical data were obtained from the computer databases and all tumor images were assessed by two authors (DJ and JK) to look for characteristic sonographic patterns. We have compared the characteristics of tumors seen in women presenting with symptoms suspicious of urinary bladder malignancy and those without such symptoms. RESULTS: Thirty women with a confirmed diagnosis of urinary bladder malignancy on histological examination were included. Median age at diagnosis was 70.5 years (range 36-88). The most common presenting symptom was postmenopausal bleeding which was recorded in 18 women (60%). Ten women (33%) had symptoms suspicious of bladder malignancy: six had unexplained visible hematuria, three had unexplained recurrent urinary tract infections and one woman had dysuria and microhematuria. On histological examination 23 women (77%) were diagnosed with primary bladder malignancy whilst seven women (23%) had metastases in the bladder from other primary tumors. Out of 23 primary tumors, 21 (91%) were of urothelial origin (12 low-grade and 9 high-grade). Most low-grade urothelial carcinomas appeared on ultrasound as irregular papillary growth (11/12, 92%) and they were moderately to highly vascular on color Doppler examination (8/12, 67%). The ultrasound appearances of primary non-urothelial and metastatic tumors varied without a clear common morphological tumor pattern. The tumors found in women with symptoms suggestive of bladder malignancy did not differ unequivocally from those detected in other women in their size, ultrasound morphology, vascularity or histological type. CONCLUSION: Urinary bladder malignancies can be detected in patients undergoing transvaginal ultrasound examination for suspected gynecological problems. Primary urothelial cancers have relatively uniform morphological pattern, whilst the appearances of other bladder malignancies are more variable. This article is protected by copyright. All rights reserved.