Prostatic hyperplasia and prostate cancer, bladder cancer, how to identify?

Clinical data

male, 60, hyperplasia of prostate for years, over the years has been dysuria, occasional nixie recently.

imaging findings

enlarged prostate, and bladder wall boundary is not clear, local thickening of bladder wall, visible soft tissue density shadow to the lumen.Enhanced scanning visible mass significantly strengthen gradually.

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results

prostatic hyperplasia

discussion

this case clinical blood in the urine, can make a lot of people first consider bladder cancer.Analysis from the diseased parts, hyperplasia of prostate cancer or tumor of maximum diameter at the site of the prostate, into the bladder tumors are located around the bladder neck, and connected to the prostate to broader base;Bump up and down diameter less than transverse diameter, only 1 ~ 2 level can be seen, bottom and side wall is normal, and mass can be separated, the bladder wall thickening and no local changes, but with bladder cancer.

(a) identification of hyperplasia of prostate and bladder cancer:

primary bladder cancer is of the highest incidence of tumors in the urinary tract, can occur in any part of the urinary bladder, part in the bladder wall, to more than 50 ~ 70 - year - old male see;And this old man also multiple hyperplasia of prostate, when hyperplasia is heavier, into bladder, can cause bladder outlet obstruction, and bladder cancer clinical symptoms are similar.The current clinical methods more for diagnosis of bladder tumor.

cystoscopy accuracy is high, but its clinical staging of tumor and tumor volume estimate is not very satisfied;And on the tumor occupied the entire bladder lumen or invasive urethra and prostate hyperplasia with urethral stricture cases, cystoscopy is not easy to success.

CT can clearly show the part of the bladder tumor and range, the depth of the tumor infiltrating bladder wall, adjacent viscera invasion and lymph node metastasis of signs;But when prostate hyperplasia inside irruptive bladder, more performance for bladder neck back wall cavity lump, similar to bladder neck carcinoma after the wall.Studies have reported that, according to the way of strengthening enhanced scan can identify with both: prostate hyperplasia of strengthening characteristics is slowly rising, with increasingly obvious reinforcement is given priority to, time - density curve is gently - type platform, and bladder cancer in the 60 s delay scan peak reinforcement, 120 s reinforcement.However, the CT improved type and improved the degree of bladder cancer reported less, here also can only for your reference.

(2) in the identification of prostatic hyperplasia and prostate cancer:

prostatic hyperplasia strengthening way is slowly rising, and shows obvious strengthening, strengthening peak CT value of up to 95 hu, strengthen the peak in the venous phase or in the real issue, and strengthen the duration long, delay to the 180 s is still more obvious reinforcement, time - density curve is gently - type platform, and with the time extension of strengthening regional uneven gradually becomes uniform reinforcement, which is consist of mainly composed of gland of the prostate and muscle fibers, hyperplasia of prostate was different by the two components.

prostate cancer strengthening way is speed up slow down, to strengthen the peak to average 58 hu, the prostatic hyperplasia significantly lower, and the peak time mostly in arterial 35 s, venous phase CT value began to slow down, and the strengthening of the hyperplasia of prostate and degree were significantly different.Domestic scholars think that prostate cancer capillaries is rich, microvascular system has high permeability, newborn blood capillary basement membrane is not complete, and more quickly make the contrast agent into the tumor tissue.Prostate cancer violate the improved performance of the central glands are consistent with the lateral cancer, identification with hyperplasia of prostate.Normal prostate central take time - density curve shape similar to prostatic hyperplasia, a slow rise - platform, but the degree of reinforcement was lower than those of prostatic hyperplasia obviously, this is because the normal prostate central dense matrix is peripheral zone, and a peripheral with more smooth muscle, relatively less peripheral zone caused by moisture content.

from the perspective of the multiphase reinforcement of this example, the delay continues to strengthen, and slow down in accordance with hyperplasia of prostate.

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