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International braz j urol

Print version ISSN 1677-5538On-line version ISSN 1677-6119

Int. braz j urol. vol.35 no.5 Rio de Janeiro Sept./Oct. 2009 






Imaging appearance of granulomatous disease after intravesical Bacille Calmette-Guerin (BCG) treatment of bladder carcinoma

Ma W, Kang SK, Hricak H, Gerst SR, Zhang J
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

AJR Am J Roentgenol. 2009; 192: 1494-500

OBJECTIVE: The purpose of our study is to present the radiographic findings in a series of 16 patients with complications associated with intravesical bacille Calmette-Guérin (BCG) treatment of bladder cancer.
CONCLUSION: Intravesical BCG-related complications such as granulomatous disease may show imaging findings mimicking primary or metastatic tumors in patients with bladder cancer. Radiologists should consider this possibility when imaging abnormalities are encountered in bladder cancer patients treated with intravesical BCG so that appropriate management can be administered and unnecessary procedures avoided.


Editorial Comment

Intravesical therapy with bacillus Calmette-Guérin (BCG) has proved to be more effective in the prophylaxis and treatment of superficial bladder tumors and carcinoma in situ than most chemotherapeutic agents. Some complications however may occur with this treatment. Granulomatous reaction may occur either in the urinary tract or sporadically outside the urinary tract (hepatitis, disseminated infection, miliary tuberculosis and polyarthritis).

This manuscript calls the attention of radiologists and urologists regarding the imaging manifestations of these complications. As it shown by the authors, granulomatous reaction may resemble focal primary renal or bladder tumors and focal or diffuse prostatic tumors. Since instillation of BCG is indicated for treatment of superficial bladder cancer, the finding of focal nodularity in the bladder wall is very difficult to differentiate from bladder cancer and bladder biopsy or surgical pathology is necessary. Similarly, transrectal biopsy of the prostate is mandatory to exclude prostate cancer in these patients.


Dr. Adilson Prando
Chief, Department of Radiology and
Diagnostic Imaging, Vera Cruz Hospital
Campinas, São Paulo, Brazil

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