Squamous Cell Carcinoma of the Bladder Mimicking Interstitial Cystitis and Voiding Dysfunction

Squamous cell carcinoma (SCC) of the bladder is a relatively uncommon cause of bladder cancer accounting for <5% of bladder tumors in the western countries. SCC has a slight male predominance and tends to occur in the seventh decade of life. The main presenting symptom of SCC is hematuria, and development of this tumor in the western world is associated most closely with chronic indwelling catheters and spinal cord injuries. A 39-year-old Caucasian female presented with bladder and lower abdominal pain, urinary frequency, and nocturia which was originally believed to be interstitial cystitis (IC) but was later diagnosed as SCC of the bladder. Presentation of SCC without hematuria is an uncommon presentation, but the absence of this symptom should not lead a practitioner to exclude the diagnosis of SCC. This case is being reported in an attempt to explain the delay and difficulty of diagnosis. Background on the risk factors for SCC of the bladder and the typical presenting symptoms of bladder SCC and IC are also reviewed. 1. Introduction In western regions, primary SCC of the bladder is uncommon with an incidence of 1.2–4.5% of all vesical tumors [1–6]. There is a slightly greater male-to-female predominance ranging from 1.25？:？1 to 1.8？:？1 for the disease, and it occurs most frequently in the seventh decade of life [6]. Several risk factors for squamous cell carcinoma of the bladder include cigarette smoking, chronic recurrent urinary tract infections (UTIs), schistosomiasis secondary to Schistosoma haematobium infection, urinary tract calculi [6–9], clean intermittent self-catheterization [10–12], long-term catheterization, and a neurogenic bladder in spinal cord injured patients [7–9]. In contrast to bladder SCC, IC sufferers tend to be female and predominantly middle-aged [13]. Typically, presenting symptoms consist of subacute development of pain on bladder filling, urinary frequency unrelieved at night, urgency, and frequency of micturition [13, 14]. Over time, patients will complain of varying degrees of symptoms without total relief at any time despite antibiotic treatment. Urine cultures are negative and some urethral/vaginal tenderness may be the only physical exam finding [13]. When present in male patients, the most common symptoms are analogous to those in females. These include suprapubic pain, urinary frequency, and dysuria [15]. 2. Case Presentation The patient was a 39-year-old white female who had a 3-year history of bladder and lower abdominal pain. Additional symptoms were urinary frequency, nocturia, a weak force of stream, and