Bladder carcinoma in a bladder diverticulum: a case report.

BACKGROUND: Bladder carcinoma arising within a bladder diverticulum is a rare but significant clinical entity. Owing to the absence of a muscularis propria in the diverticular wall, these tumors have a higher propensity for early invasion and present unique challenges in diagnosis and management. The most common histology is urothelial carcinoma, though squamous cell carcinoma and adenocarcinoma may also occur. Treatment options vary based on patient condition, tumor stage, with surgical excision being the primary modality. This paper presents a case of bladder carcinoma in a diverticulum treated by transurethral resection owing to advanced age and comorbidities, followed by a discussion of diagnostic and management strategies.

CASE PRESENTATION: A 87-year-old Caucasian non-Hispanic male with a history of benign prostatic hyperplasia with painless gross hematuria and irritative voiding symptoms. Imaging studies, including Ultrasound and computed tomography urography revealed a bladder diverticulum containing a soft tissue mass. Cystoscopy biopsy confirmed noninvasive low-grade papillary urothelial carcinoma with benign muscularis propria. Owing to the patients age and concomitant medical conditions, he underwent transurethral resection, and pathology confirmed pT1 disease. The postoperative course was uneventful, and follow-up cystoscopy at 6 months showed local recurrence.

CONCLUSION: Bladder carcinoma in a diverticulum requires a high index of suspicion for timely diagnosis. Given the structural limitations of diverticular walls, transurethral resection may be inadequate, necessitating surgical excision for definitive management. Early detection and a multidisciplinary approach are essential to improving patient outcomes. Close follow-up is imperative due to the increased risk of recurrence and progression.