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A rare coincidence and recurrent urinary tract infections
  1. D Debnath,
  2. D G Richards
  1. West Cumberland Hospital, Whitehaven, Cumbria
  1. Mr D Debnath, c/o Norton House, Grantham and District Hospital, 101 Manthorpe Road, Grantham, Lincolnshire NG31 8DG, UKdebnath10{at}hotmail.com

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Answers on p 129.

A 68 year old woman was referred for recurrent episodes of urinary tract infection and weight loss of four months' duration. She gave a history of intermittent brownish discharge from her urethra for the same duration but was otherwise asymptomatic. There was no significant past medical history. Laboratory evaluation revealed a haemoglobin level of 100 g/l, leucocyte count of 11.0 × 109/l, and a positive urine culture (Escherichia coli). A rigid cystoscopy was performed which readily confirmed the diagnosis. A biopsy specimen, which was taken during cystoscopy, showed transitional cell carcinoma.

Computed tomography of abdomen and pelvis (fig 1) was arranged. There was no nodal spread or liver metastasis. She subsequently underwent laparotomy that revealed the fistulous communication between sigmoid colon and roof of the bladder. A defunctioning colostomy was performed. She was recalled after six weeks for a second operation that entailed a total cystectomy (along with ileal conduit formation) and low anterior resection with closure of the rectal stump and left iliac fossa colostomy. Her postoperative recovery was uneventful.

Figure 1

Computed tomography of abdomen and pelvis.

The whole specimen was sent to the pathologist for further evaluation (fig 2 is the microphotograph of relevant section of the histology).

Figure 2

Histology (haematoxylin and eosin; original magnification × 100).

Questions

(1)
What is the initial diagnosis?
(2)
What and how common are the histological findings?
(3)
What is the prognosis?

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