Metastatic transitional cell carcinoma of the bladder in an ileal conduit stoma. A case report and literature review
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v81i2.621Keywords:
Bladder cancer, Metastasis, Ileal conduit stomaAbstract
Clinical case presentation: An 80-year-old man was admitted to our emergency department due to fever and progressively growing mass in the urinary diversion stoma four months after a radical cystectomy for muscle invasive bladder cancer.
Surgical resection was done, and histo-pathological examination revealed metastases of high-grade urothelial carcinoma. After almost three years of follow-up any sign of recurrence did not seen.
Relevance: Urothelial cancer at all stages can metastasize to other organs.
Metastasis occurs hematogenously to all organs, most frequently the lungs, liver, bone, or lymphatically to regional lymph nodes in the pelvis, or further to retroperitoneal lymph nodes. Metastasis of bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has-been reported in ureteroileal anastomosis.
Clinical implications: Surgical treatment is an option in these patients. Adjuvant radiotherapy and / or chemotherapy would be possible alternatives in more than one site of metastasis. There are no clinical guidelines establishing their correct management.
Conclusion: The urinary diversion stoma metastases secondary to a urothelial carcinoma is a rare entity. Direct implantation during the surgical act, hematogenous, lymphatic or mixed dissemination, could justify metastatic implantation.
References
Babjuk M, Böhle A, Burger M, Capoun O, Cohen D, Compérat EM, et al. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol. 2017;71(3):447–61. doi: 10.1016/j.eururo.2016.05.041
Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin M-E, Van den Abbeele AD. Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol. 2011;196(1):117–22. doi: 10.2214/AJR.10.5036
Sánchez Zalabardo D, López Ferrandis J, Arocena García-Tapia J, Sanz Pérez G, Zudaire Bergera J, Berían Polo Jm. Recurrent urothelial tumor in orthotopic neobladder. Actas Urol Esp. 2001;25(8):600–2. doi: 10.1016/s0210-4806(01)72681-2
Barba Abad JF, Tolosa Eizaguirre E, Rincón Mayans A, Berian Polo J. Recidiva tumoral en sustitución vesical ortotópica. A propósito de dos casos y revisión de la literatura médica. Actas Urológicas Españolas. 2010;34(3):295–7. doi: 10.1016/j.acuro.2009.10.002
Curran FT, Fuggle WJ. Transitional cell carcinoma in an ileal conduit. Postgraduate Medical Journal. 1986;62(730):769–71. doi: 10.1136/pgmj.62.730.769
Rosvanis TK, Rohner TJ, Abt AB. Transitional cell carcinoma in an ileal conduit. Cancer. 1989;63(6):1233–6. doi: https://doi.org/10.1002/1097-0142(19890315)63:6<1233::AID-CNCR2820630633>3.0.CO;2-7
Elawdy MM, Osman Y, Taha DE, El-Halwagy S. Muscle-invasive bladder and urethral cancer recurrence after surgical management of upper tract urothelial carcinoma: A review of 305 patients. Turk J Urol. 2018;44(3):213–20. doi: 10.5152/tud.2018.19677
Grabstald Harry. Carcinoma of Ileal Bladder Stoma. Journal of Urology. 1974;112(3):332–4. doi: 10.1016/S0022-5347(17)59722-0
Gupta C. & Rajeev K. Ileal Conduit stoma site metastasis in squamous cell carcinoma of urinary bladder. BJUI. 2011 Jun 24.
Inobe T, Kanda K, Murakami Y, Tsuji M, Tamura M, Kagawa S. Recurrent bladder adenocarcinoma in an ileal conduit stoma: A case report. International Journal of Urology. 1999;6(9):467–70. doi: https://doi.org/10.1046/j.1442-2042.1999.00094.x
Kunju Lakshmi P., You Li, Zhang Yingxi, Daignault Stephanie, Montie James E., Lee Cheryl T. Lymphovascular Invasion of Urothelial Cancer in Matched Transurethral Bladder Tumor Resection and Radical Cystectomy Specimens. Journal of Urology. 2008;180(5):1928–32. doi: 10.1016/j.juro.2008.07.056
