Squamous Cell Carcinoma in Exstrophy of the Bladder
The patient, a 36-year-old woman with a known case of exstrophy of the bladder had undergone repair of the defect 17 years previously. However, dehiscence of the repair had occurred and the patient continued to leak urine from the lower abdominal wall. Six months following this, an ileal conduit urinary diversion was done to prevent the continuous leakage of urine. Six month prior to presentation, the patient had noticed an irregular mass arising from the exposed bladder mucosa that was rapidly increasing in size. On examination, a hemispherical growth with an irregular surface was seen in the region of the exposed bladder mucosa (). The computed tomography scan showed a mildly enhancing nodular lesion on the right side of the lower abdomen superficially. The lesion was confined to the urinary bladder. A wedge biopsy was taken from the growth, and the results were suggestive of squamous cell carcinoma. The results of a routine hematological evaluation, liver function tests, and a chest radiograph were normal. The patient thus underwent removal of the urinary bladder along with a cuff of the surrounding abdominal wall and pelvic lymph node dissection (radical cystectomy). After resection, there was a full thickness defect of the lower abdomen about 8 cm×9 cm in size. To cover this defect, the peritoneum was mobilized on both sides and was sutured in the midline. Both recti were also mobilized and sutured in the midline. The skin defect was resurfaced with an extended groin flap from the left side and the secondary defect thus created was covered by a split thickness skin graft (, ). Histopathological examination of the resected specimen was suggestive of well-differentiated squamous cell carcinoma infiltrating the underlying muscle (stage pT2a) with dense lymphocytic infiltration of the stroma. All the resected margins and deeper plane of resection were free of tumor (). In the postoperative period, the patient developed a small collection beneath the flap that was drained by removal of two stitches, and daily dressings were done. This site granulated well and healed without any significant additional scaring. The patient is on regular follow-up and is doing well without any evidence of recurrence to date (5 months postoperatively) ().