LYMPHOMA AFFECTING THE URINARY BLADDER IN THREE DOGS AND

A CAT

LIVIA BENIGNI, CHRISTOPHER R. LAMB, NURIA CORZO-MENENDEZ, ANDREW HOLLOWAY, JANE M. EASTWOOD

Three dogs and one cat with lymphoma affecting the urinary bladder are reported and the findings on abdominal
radiographs and ultrasound are described. Mural lesions representing lymphoma affecting the urinary bladder
were identified ultrasonographically in all animals. The most common complications associated with urinary
bladder lymphoma were hydronephrosis and hydroureter. In two patients contrast radiography was necessary to
detect leakage of urine in the peritoneal and retroperitoneal space. The radiographic and ultrasonographic signs
were similar to those reported with other urinary bladder neoplasms; hence urinary bladder lymphoma could not
be distinguished from the more common urinary bladder neoplasms, such as transitional cell carcinoma. It is
important to include lymphoma in the differential diagnosis of urinary bladder wall thickening and mural mass
in dogs and cats. Veterinary Radiology & Ultrasound, Vol. 47, No. 6, 2006, pp 592–596.

Key words: bladder, cat, dog, lymphoma, urinary.

Introduction Case History Reports

T he majority of canine and feline urinary bladder

tumors are malignant and of epithelial origin.1–3 The
most frequently encountered bladder tumor is transitional
Dog 1
An 8-year-old, neutered female Weimaraner had an in-
sulinoma surgically removed and was clinically well when
cell carcinoma, followed by squamous cell carcinoma, ad-
presented for a routine recheck 1 year later. Submandib-
enocarcinoma and undifferentiated carcinoma. The most
ular and superficial cervical lymphadenopathy was found
common non-epithelial tumors are leiomyomas and leio-
on physical examination. On biochemistry there was mild
myosarcomas, hemangiomas and hemangiosarcomas, fi-
azotemia (urea 14.6 mmol/l, normal range 3–9.1 mmol/l;
bromas, and fibrosarcomas. The prognosis for malignant
creatinine 190 mmol/l, normal range 98–163 mmol/l). Urine
epithelial tumors is poor because of their invasive character
specific gravity was 1.028, pH was 7, with increased protein
and their tendency to occur at the urinary bladder trigone.
and blood. Analysis of the sediment revealed 600 red blood
Survival time following excision of bladder carcinoma is
cells and 70 white blood cells per high-power field. Thor-
usually less than 6 months. Surgical excision of a benign
acic radiographs were unremarkable.
urinary bladder tumor may be curative but the prognosis
Abdominal ultrasonographic findings were hypoechoic
depends on the location and size of the tumor, which de-
nodules in the liver and spleen, splenic and mesenteric
termine its resectability.
lymphadenopathy, slight peritoneal fluid (not enough for
Lymphoma affecting the urinary bladder in dogs and
centesis), moderate right hydronephrosis, right hydroure-
cats has been reported rarely.4-8 There is limited informa-
ter, and urinary bladder wall mass. The mass was hetero-
tion about the ultrasonographic and radiographic appear-
geneous, with a broad base and arising from the ventral
ance of this disease; no ultrasonographic illustration of the
wall of the urinary bladder. It had a well-defined and
disease in the dog could be found. Urinary bladder lymph-
smooth mucosal surface, and there was evidence of irregu-
oma is also very rare in humans. It appears to be more
lar serosal outline suggesting invasion though the serosa
common in women than men and it is thought to originate
(Fig. 1). Ultrasound-guided biopsy of the urinary bladder
in the mucosa-associated lymphoid tissue.9,10
mass was performed; the histologic diagnosis was lymph-
oma. The dog returned to its local veterinary practice for
From The Queen Mother Hospital for Animals, The Royal Veterinary treatment but was euthanized after 1 month.
College, University of London, Hawkshead Lane, North Mymms, Hert-
fordshire AL9 7TA, UK (Benigni, Lamb and Eastwood), from Davies
Veterinary Specialist (Corzo-Menendez), and from The Queen’s Veterin- Dog 2
ary School Hospital, University of Cambridge, Cambridge, UK (Hollo-
way). A 7-year-old, neutered male Springer Spaniel had a
Address correspondence and reprint requests to Livia Benigni, at the 3-week history of hematuria and more recent stranguria.
above address. E-mail: lbenigni@rvc.ac.uk
Received December 12, 2005; accepted for publication May 9, 2006. There were signs of caudal abdominal pain and pros-
doi: 10.1111/j.1740-8261.2006.00192.x tatomegaly. There was gross hematuria. On abdominal

592
Vol. 47, No. 6 LYMPHOMA AFFECTING THE URINARY BLADDER 593

Fig. 1. Ultrasound of dog 1. (A) A heterogeneous mass with smooth mucosal surface affects the ventral bladder wall and (B) upon 1 year follow-up
examination, the mural mass is larger and invading the peritoneal cavity through the serosa (arrow).

radiographs, the prostate appeared enlarged and there was
increased soft tissue opacity in the caudal sublumbar region
compatible with medial iliac lymphadenopathy. Ultrasono-
graphically there was marked right hydronephrosis and right
hydroureter, perinephric and medial iliac lymphadenopathy,
an enlarged prostate, retroperitoneal fluid and a large urin-
ary bladder mass (Fig. 2). The mass affected the bladder
trigone, slightly towards the right; it was heterogeneous, with
an irregular mucosal surface and evidence of serosal inva-
sion. On analysis the retroperitoneal fluid was consistent with
an exudate, and the urea and creatinine levels in the fluid
were not suggestive of urinary tract rupture. Urine cytology
and fine needle aspirates from the medial iliac lymph nodes
and prostate revealed lymphoma. Although the dog was
doing well after ten days of chemotherapy, he was euthani-
zed 2 weeks later because of severe anemia and signs of early
renal failure. Before euthanasia an ultrasonographic exam-
ination showed the urinary bladder mass was similar to the
initial examination; the retroperitoneal fluid was not seen.
Dog 3
A 4-year-old, neutered male Labrador had chronic
vomiting, weight loss, lethargy, and diarrhea. The dog
was dull and subdued with abdominal pain. There was
azotemia with a high urea (32.3 mmol/l, normal range
2.8–9 mmol/l) and creatinine (554 mmol/l, normal range
68–104 mmol/l). There was also neutrophilia (30.4  109/l,
normal range 3–11.7  109/l) and monocytosis (2.8  109/l,
normal range 0.2–1.7  109/l). The urinary specific gravity
was low at 1.010, with a trace of blood and occasional
white cells in the sediment.
Ultrasonographically there was bilateral hydronephrosis
and hydroureter more marked on the left. The bladder
trigone was mildly thickened (6 mm) with a well-defined
mucosal surface. A mass was found adjacent to the right
kidney. There was retroperitoneal fluid.
Excretory urography was performed and both the right
and left kidney were seen to excrete contrast medium. Dil-
atation of the left renal pelvis and proximal left ureter were
observed. The left ureter had an irregular circumferential
narrowing close to the ureterovesicular junction but was
inserting in the normal position and emptying into the
urinary bladder. The right renal pelvis and proximal right
ureter were dilated but more distally the ureteric outline
was lost with leakage of contrast medium into the retro-
peritoneal space. A retrograde double contrast urethrocys-
togram confirmed the thickening of the urinary bladder
wall, the urethra was normal. Thoracic radiographs were
unremarkable.

Fig. 2. Ultrasound of dog 2. Note (A) the right renal pelvis dilatation, (B) the dilated right ureter entering the trigone at the level of a mural mass, and (C)
medial iliac lymphadenopathy.
594
At exploratory laparotomy the right kidney and right
ureter were removed and biopsies from the right kidney,
both ureters and urinary bladder were submitted for his-
topathology; the diagnosis was T-cell lymphoma affecting
each of these organs.
The dog received chemotherapy and responded well for
6 months. Periodic physical and ultrasonographic reassess-
ment showed no lymph node enlargement and normal ap-
pearance of the urinary bladder neck. Six month after
diagnosis the dog had vomiting, depression, and collapse
after vincristine administration. All chemotherapeutic treat-
ment was stopped. The dog was doing well at a follow-up
consultation 2–3 weeks later, but was euthanized 2 weeks
later after developing neurologic signs, including seizures.
Cat
A 1-year-old, neutered female Domestic Short Hair cat
had weight loss, inappetence, urinary incontinence, and
hematuria. There was ascites and a caudal abdominal mass
was palpated. There was also a mature neutrophilia
(20.1  109/l, normal range 2.5–12.5  109/l) and elevated
potassium (7.1 mmol/l, normal range 3.5–5.5 mmol/l), urea
(45.3 mmol/l, normal range 4–11 mmol/l), creatinine (497
mmol/l, normal range 40–180 mmol/l), bile acids (80.1 mmol/l,
normal range 0–15 mmol/l), and glucose (6.7 mmol/l, normal
range 3.5–5.8 mmol/l). Urine specific gravity was 1.014;
a few red blood cells were present in the urine. Feline
leukemia virus antigen test was positive.
Ultrasonographically there was a heterogeneous, broad
based, mural mass centered on the urinary bladder trigone.
This mass had a lumpy but well-defined mucosal surface,
the serosal outline was irregular suggesting local invasion
through serosa (Fig. 3). There were bilateral perinephric
cysts, increased renal medullary echogenicity, bilateral mild
hydronephrosis, and peritoneal fluid. Analysis of the peri-
toneal fluid was consistent with uroabdomen.
Fig. 3. (A) Retrograde vaginourethrocystogram of the cat. Note thickening of the dorsal bladder wall and extravasation of contrast medium into the
peritoneal cavity (arrow). (B) Ultrasound of the cat bladder. Note the heterogeneous mass centered on the bladder trigone with lumpy but well defined mucosal
surface (upper arrow) and invasion of the peritoneal cavity through the serosa (lower arrows).
BENIGNI ET AL. 2006
Excretory urography confirmed a mild bilateral dilata-
tion of the renal pelvises. In a retrograde positive contrast
vaginourethrocystogram there was a lumpy, well margin-
ated, mass on the dorsal urinary bladder wall and intra-
peritoneal leakage of contrast medium from the area of the
bladder trigone (Fig. 3).
The cat underwent exploratory laparotomy and the urin-
ary leakage was found to be originating from a rupture in
the dorsal part of the urinary bladder. The patient was
euthanized during surgery when it was determined that the
rupture was located within the urinary bladder mass which
was too extensive for resection. Biopsies of the urinary
bladder were taken; the histologic diagnosis was lymphoma.
Discussion
In this series, urinary bladder lymphoma appeared on
ultrasound as a heterogeneous mural mass in three out of
four patients and with a well-defined luminal–mucosal
interface in three out of four patients. There is little existing
information about the ultrasonographic appearance of
urinary bladder lymphoma with which to compare our
findings. In one report urinary bladder lymphoma in a cat
was described ultrasonographically as a homogeneous,
smooth-margined mass with a hyperechoic elliptical area
attached to the caudal aspect of the main mass; however, if
the main mass and the hyperechoic area are considered as
part of the same lesion, this could be described as hetero-
geneous.8 In other reports urinary bladder lymphoma is
described superficially as a large lobular mass occupying
the urinary bladder,7 and as a thickening of the bladder
wall at level of the urinary bladder neck.6 An ultrasono-
graphically well-marginated luminal mucosal interface was
found in a dog with lymphoma of the penile urethra.11
In the patients reported here, the ultrasonographic
findings were suggestive of mucosal and/or submucosal
infiltration, which corresponds with the usual histologic
Vol. 47, No. 6 LYMPHOMA AFFECTING THE URINARY BLADDER
description of urinary bladder lymphoma as an infiltration
of the mucosal and submucosal layers of the bladder wall
originating from encapsulated secondary lymphoid tissue.5,7
The bladder trigone and dorsal urinary bladder wall
were predominantly affected (three patients), but ventral
urinary bladder wall localization was also found (one pa-
tient). In previous reports lymphoma affecting the urinary
bladder was localized in the ventral urinary bladder wall in
a dog,7 in the dorsocranial aspect of the bladder wall in a
cat8 and at the bladder neck in another cat.6 Therefore,
lymphoma can affect any part of the urinary bladder wall
and, from the limited reports, is not possible to determine if
there is a predilection site for urinary bladder lymphoma.
Multiple, red, protruding nodules of 4–5 mm in diameter
scattered throughout the mucosa and a thick urinary blad-
der wall were macroscopically observed in a cat affected by
urinary bladder lymphoma; in this cat no information of
the ultrasonographic or radiographic appearance was given.5
Transitional cell carcinomas are irregularly shaped, ses-
sile, and frequently have an abrupt transition between the
tumor and normal mucosa,12 whereas in lymphoma a long
transition zone was observed between the tumor and nor-
mal thickness bladder wall. Both types of tumor can invade
adjacent tissue through the serosa. Lymphoma and tran-
sitional cell tumor more often have a heterogeneous echo-
genicity; urinary bladder smooth muscle neoplasia can be
hypoechoic or heterogeneous.12,13 On the basis of these
patients, we believe that lymphoma cannot be easily dif-
ferentiated from smooth muscle tumor.
Results of color Doppler investigation were not recorded
in our patients; but this information would have been use-
ful to compare it with the appearance of other urinary
bladder tumors. Imaging findings are not specific for these
tumors but patterns of growth and tumor characteristics
may allow differentiation. In humans computed tomogra-
phy and magnetic resonance imaging are now considered
the imaging modalities of choice for accurate tumor dif-
ferentiation and tumor staging.14
The most common complications associated with urin-
ary bladder lymphoma were hydronephrosis and hydro-
ureter. Hydronephrosis and hydroureter are also reported
to be frequently associated with transitional cell carcin-
oma.12 Ultrasound enabled visualization of the urinary
bladder wall echotexture and assessment of the mucosal-
lumen interface and serosal outline, which were not
appreciated on radiographic examination.
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595
Where retroperitoneal and/or peritoneal fluid is found
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throcystography are recommended to detect a possible
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In two patients contrast radiography proved necessary to
detect leakage of urine in the peritoneal and retroperitoneal
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be included in the differential diagnosis of urinary bladder
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