-- RadioGraphics 1997; 17: 919-937

Figure 3: Rhabdomyosarcoma of the prostate with bladder invasion in a 5-year-old boy with a history of neurofibromatosis. Panel A Longitudinal sonogram of the pelvis demonstrates a dominant extraluminal component (straight black arrows) and intraluminal extension (white arrow) of a large, heterogeneous, hypoechoic soft-tissue mass at the bladder base, as well as a thickened posterior bladder wall (curved arrow). Panel B Lateral radiograph from a cystographic study shows an irregular filling defect (arrow) at the bladder base and marked superior displacement of the opacified urinary bladder. Panel C Contrast material-enhanced computed tomographic (CT) scan shows the large, lobulated, soft-tissue mass (arrows) at the posteroinferior aspect of the urinary bladder. The mass contains scattered foci of fluid attenuation and displaces a Foley catheter (arrowhead) to the right. Panel D Midline sagittal T1-weighted (repetition time msec/echo time msec = 583/20) magnetic resonance (MR) image shows the large mass (arrows), which has a signal intensity similar to that of skeletal muscle, extending superiorly into the pelvis from the region of the prostate. The precise origin of the mass is difficult to determine. Panel E Midline sagittal T1-weighted MR image (400/20), obtained after combined chemotherapy and radiation therapy and 2 days before cystoprostatectomy, shows the residual soft-tissue mass containing foci of lower signal intensity (straight arrows), which became bright on T2-weighted images (not shown). Increased signal intensity of the lumbosacral vertebral bodies (curved arrow) is compatible with postirradiation change. Panel F Photograph of the cystoprostatectomy specimen sectioned sagittally demonstrates the lobulated residual mass containing myxoid areas (straight arrows), corresponding to the foci of low signal intensity shown in E. The bladder neck (curved arrow) is narrowed and elongated, and the bladder wall (arrowhead) is markedly thickened.

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