Abstract
Objective
The purpose of this article is to present a contemporary review of the imaging appearance of diseases which affect the deeper layers of the urinary bladder, including both suburothelial and extrinsic pathologies, using radiologic–pathologic correlation.
Conclusion
Compared to the more common urothelial lesions, at cystoscopy, suburothelial and extrinsic diseases of the urinary bladder wall often have a non-specific appearance or may be occult. Cross-sectional imaging, in particular MRI, plays an integral role in diagnosis. Mesenchymal tumors have distinct imaging features on MRI. Leiomyomas are characteristically low signal intensity on T2-weighted (T2W) imaging and progressively enhance. Lipomas and lipomatous hypertrophy are diagnosed by the presence of macroscopic fat. Neurofibromas, hemangiomas, and paragangliomas are hyperintense on T2W sequences and hypervascular. Reactive lesions occur in the setting of chronic inflammation and include: nephrogenic adenoma, cystitis cystica, and cystitis glandularis. Imaging findings are commonly non-specific; however, a mass with internal cystic spaces in association with pelvic lipomatosis is suggestive of cystitis glandularis. Urachal anomalies may be complicated by infection or malignancy. Urachal mucinous adenocarcinoma has a poor prognosis and may present as a T2-hyperintense suburothelial/extrinsic mass centered in the bladder dome. Other diseases may extrinsically involve the urinary bladder by hematogenous and peritoneal spread, including infection, endometriosis, and malignancy. A familiarity with suburothelial and extrinsic pathologies of the urinary bladder is critical for the radiologist, who may be the first to suggest these diagnoses.
Similar content being viewed by others
References
Wood DP (2012) Chapter 80. Urothelial tumors of the bladder. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbell-Walsh urology, vol. 10e. Philadelphia: Saunders, pp 2309–2334
Konety BR, Carroll PR (2013) Chapter 21. Urothelial carcinoma: cancers of the bladder, ureter, & renal pelvis. In: McAninch JW, Lue TF (eds) Smith & Tanagho’s general urology, vol. 18e. New York: The McGraw-Hill Companies
Tanagho EA, Lue TF (2013) Chapter 1. Anatomy of the genitourinary tract. In: McAninch JW, Lue TF (eds) Smith & Tanagho’s general urology, vol. 18e. New York: The McGraw-Hill Companies
Petersen RO, Sesterhenn IA, Davis CJ (2009) Chapter 3. Urinary bladder. Urologic pathology, vol. 3e. Philadelphia: Lippincott Williams & Wilkins, pp 175–283
Barentsz J, Jager G, Witjes J, Ruijs J (1996) Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT. Eur Radiol 6:129–133
Tekes A, Kamel I, Imam K, et al. (2005) Dynamic MRI of bladder cancer: evaluation of staging accuracy. AJR Am J Roentgenol 184:121–127
de Haas RJ, Steyvers MJ, Futterer JJ (2014) Multiparametric MRI of the bladder: ready for clinical routine? AJR Am J Roentgenol 202:1187–1195
Narumi Y, Kadota T, Inoue E, et al. (1993) Bladder wall morphology: in vitro MR imaging-histopathologic correlation. Radiology 187:151–155
Kim B, Semelka RC, Ascher SM, et al. (1994) Bladder tumor staging: comparison of contrast-enhanced CT, T1- and T2-weighted MR imaging, dynamic gadolinium-enhanced imaging, and late gadolinium-enhanced imaging. Radiology 193:239–245
Chen M, Lipson SA, Hricak H (1997) MR imaging evaluation of benign mesenchymal tumors of the urinary bladder. AJR Am J Roentgenol 168:399–403
Blasco Casares FJ, Sacristan Sanfelipe J, Ibarz Servio L, Batalla Cadira JL, Ruiz Marcellan FJ (1995) Characteristics of bladder leiomyoma in our setting. Archivos Espanoles de Urologia 48:987–990
Cornella JL, Larson TR, Lee RA, Magrina JF, Kammerer-Doak D (1997) Leiomyoma of the female urethra and bladder: report of twenty-three patients and review of the literature. Am J Obstet Gynecol 176:1278–1285
Wong-You-Cheong JJ, Woodward PJ, Manning MA, Sesterhenn IA (2006) From the Archives of the AFIP: neoplasms of the urinary bladder: radiologic-pathologic correlation. Radiographics 26:553–580
Kabalin JN, Freiha FS, Niebel JD (1990) Leiomyoma of bladder. Report of 2 cases and demonstration of ultrasonic appearance. Urology 35:210–212
Goluboff ET, O’Toole K, Sawczuk IS (1994) Leiomyoma of bladder: report of case and review of literature. Urology 43:238–241
Namimoto T, Awai K, Nakaura T, et al. (2009) Role of diffusion-weighted imaging in the diagnosis of gynecological diseases. Eur Radiol 19:745–760
Sundaram CP, Rawal A, Saltzman B (1998) Characteristics of bladder leiomyoma as noted on magnetic resonance imaging. Urology 52:1142–1143
Martin SAMD, Sears DLMD, Sebo TJMD, Lohse CMBS, Cheville JCMD (2002) Smooth muscle neoplasms of the urinary bladder: a clinicopathologic comparison of leiomyoma and leiomyosarcoma. Am J Surg Pathol 26:292–300
Iczkowski KA, Shanks JH, Gadaleanu V, et al. (2001) Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. Mod Pathol 14:1043–1051
Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ (2006) From the archives of the AFIP: inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics 26:1847–1868
Levy AD, Patel N, Dow N, et al. (2005) Abdominal neoplasms in patients with neurofibromatosis type 1: radiologic-pathologic correlation. RadioGraphics 25:455–480
Cheng L, Scheithauer BW, Leibovich BC, et al. (1999) Neurofibroma of the urinary bladder. Cancer 86:505–513
Cheng L, Nascimento AG, Neumann RM, et al. (1999) Hemangioma of the urinary bladder. Cancer 86:498–504
Garg AG, Samir AE (2011) Chapter 108. Benign bladder lesions. In: Sahani DV, Samir AE (eds) Abdominal imaging. Maryland Heights: Saunders, pp 1217–1223
Meraj S, Narasimhan G, Gerber E, Nagler HM (2002) Bladder wall lipoma. Urology 60:164
Kunkle DA, Mydlo JH (2005) Bladder wall lipoma in patient with irritative voiding symptoms. Urology 66:653–654
Kriegshauser JS, Conley CR, Hentz JG (2013) Bladder wall fat on computed tomography with pathologic correlation. Clin Imaging 37:509–513
Thickman D (2009) Fat within the wall of the urinary bladder: computed tomographic appearance. J Comput Assist Tomogr 33:695–697
Philip ATMD, Amin MBMD, Tamboli PMD, et al. (2000) Intravesical adipose tissue: a quantitative study of its presence and location with implications for therapy and prognosis. Am J Surg Pathol 24:1286–1290
Crecelius SA, Bellah R (1995) Pheochromocytoma of the bladder in an adolescent: sonographic and MR imaging findings. Am J Roentgenol 165:101–103
Zhou M, Epstein JI, Young RH (2004) Paraganglioma of the urinary bladder: a lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens. Am J Surg Pathol 28:94–100
Wang H, Ye H, Guo A, et al. (2011) Bladder paraganglioma in adults: MR appearance in four patients. Eur J Radiol 80:e217–e220
Smith AK, Hansel DE, Jones JS (2008) Role of cystitis cystica et glandularis and intestinal metaplasia in development of bladder carcinoma. Urology 71:915–918
Pavlidakey PG, MacLennan GT, Goldman HB (2010) Nephrogenic adenoma of the bladder. J Urol 184:2535–2536
Yu J, Kim KW, Lee H, et al. (2001) Urachal remnant diseases: spectrum of CT and US findings. RadioGraphics 21:451–461
Naiditch JA, Radhakrishnan J, Chin AC (2013) Current diagnosis and management of urachal remnants. J Pediatr Surg 48:2148–2152
Ashley RA, Inman BA, Routh JC, et al. (2007) Urachal anomalies: a longitudinal study of urachal remnants in children and adults. J Urol 178:1615–1618
Thali-Schwab CM, Woodward PJ, Wagner BJ (2005) Computed tomographic appearance of urachal adenocarcinomas: review of 25 cases. Eur Radiol 15:79–84
Hussain SM, Outwater EK, Siegelman ES (2000) MR imaging features of pelvic mucinous carcinomas. Eur Radiol 10:885–891
Haider EA, Jhaveri KS, O’Malley ME, et al. (2008) Magnetic resonance imaging of the urinary bladder: cancer staging and beyond. Can Assoc Radiol J 59:241–258
Habuchi T, Okagaki T, Miyakawa M (1991) Endometriosis of bladder after menopause. J Urol 145:361–363
Taguchi S, Enomoto Y, Homma Y (2012) Bladder endometriosis developed after long-term estrogen therapy for prostate cancer. Int J Urol 19:964–965
Bazot M, Darai E, Hourani R, et al. (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389
Bates Baithun (2000) Secondary neoplasms of the bladder are histological mimics of nontransitional cell primary tumours: clinicopathological and histological features of 282 cases. Histopathology 36:32–40
Bates AW, Norton AJ, Baithun SI (2000) Malignant lymphoma of the urinary bladder: a clinicopathological study of 11 cases. J Clin Pathol 53:458–461
Cotton F, Pellet O, Gilly FN, et al. (2006) MRI evaluation of bulky tumor masses in the mesentery and bladder involvement in peritoneal carcinomatosis. Eur J Surg Oncol 32:1212–1216
Ricke J, Sehouli J, Hach C, et al. (2003) Prospective evaluation of contrast-enhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer. Eur Radiol 13:943–949
Iafrate F, Ciolina M, Sammartino P, et al. (2012) Peritoneal carcinomatosis: imaging with 64-MDCT and 3T MRI with diffusion-weighted imaging. Abdom Imaging 37:616–627
Yu NC, Raman SS, Patel M, Barbaric Z (2004) Fistulas of the genitourinary tract: a radiologic review. RadioGraphics 24:1331–1352
Goldman SM, Fishman EK, Gatewood OM, Jones B, Siegelman SS (1985) CT in the diagnosis of enterovesical fistulae. AJR Am J Roentgenol 144:1229–1233
Margolis T, Mercer LJ (1994) Vesicovaginal fistula. Obstet Gynecol Surv 49:840–847
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chung, A.D., Schieda, N., Flood, T.A. et al. Suburothelial and extrinsic lesions of the urinary bladder: radiologic and pathologic features with emphasis on MR imaging. Abdom Imaging 40, 2573–2588 (2015). https://doi.org/10.1007/s00261-015-0467-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-015-0467-z