A 35-year-old male with a long standing history of diabetes, hypertension and proteinuria presented with painless hematuria. Renal ultrasound showed a 5 cm right lateral wall bladder mass (fig. 1). Subsequent computerized tomography of the chest, abdomen and pelvis confirmed the presence of an enhancing mass (fig. 2) but did not demonstrate lymphadenopathy or distant metastatic disease. Based on the imaging of the mass, the primary diagnostic considerations were epithelial tumors, including urothelial carcinoma, and nonepithelial tumors, including leiomyoma and sarcoma.
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