MRI features of the nested variant of urothelial carcinoma of the urinary bladder: report of four cases
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MRI features of the nested variant of urothelial carcinoma of the urinary bladder: report of four cases Kaori Yamada1 · Yasuteru Sasakura1 · Sachimi Yamada1 · Hitomi Nagano1 · Koshi Terayama1 · Masato Fujita1 · Nana Kozawa2 · Mitsuo Kishimoto3 · Kei Yamada4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We report on four patients with the nested variant of urothelial carcinoma (NVUC) of the urinary bladder and focus on their magnetic resonance imaging (MRI) findings. MRI showed that all lesions had irregular wall thickening with little protrusion into the bladder lumen. All had extravesical invasion, and two had invaded other organs (uterus and seminal vesicle). On T2-weighted images, all tumors mainly showed relatively strong hypointensity similar to that of the muscularis propria, and in three cases there was also a thin hyperintense layer on the tumor surface, suggesting edematous mucosa. Diffusionweighted images demonstrated different degrees of hyperintensity, which was faint in one case. Dynamic contrast-enhanced MRI was performed in two cases and both showed gradual contrast enhancement. It has been suggested that NVUC may produce unique MRI findings reflecting its pathological features. It would be useful for those who interpret bladder MRI to recognize this rare urothelial carcinoma variant. Keywords Bladder cancer · Nested variant of urothelial carcinoma · MRI
Introduction The nested variant of urothelial carcinoma (NVUC) is classified as a rare subtype of invasive urothelial carcinoma that accounts for approximately 0.3% of all invasive urothelial carcinomas [1]. Although the tumor has a bland histomorphologic appearance and has at times been misdiagnosed as a benign lesion [2], it is a clinically important subtype with poor prognosis. Its radiological findings have rarely been
* Kaori Yamada [email protected]‑m.ac.jp 1
Department of Diagnostic Radiology, Kyoto Second Red Cross Hospital, 355‑5 Haruobi‑cho, Kamigyo‑ku, Kyoto 602‑8026, Japan
2
Department of Radiology, Japan Community Health care Organization Kyoto Kuramaguchi Medical Center, 27 Shimofusa‑cho, Kita‑ku, Kyoto 603‑8151, Japan
3
Department of Surgical Pathology, Kyoto Prefectural University of Medicine, 465 Kajii‑cho, Kamigyo‑ku, Kyoto 602‑8566, Japan
4
Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii‑cho, Kamigyo‑ku, Kyoto 602‑8566, Japan
reported and to date no reports have focused on imaging findings with detailed explanations. We report our experience with four cases of NVUC of the urinary bladder, with a focus on their magnetic resonance imaging (MRI) findings, and compare these findings with pathological features.
Case reports Case 1 A 64-year-old woman presenting with frequent urination had been diagnosed with cystitis in another clinic and took an anticholinergic drug. However, her symptoms did not improve and she was referred to our hospital. Her physical examination was normal. She had a history of sur
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