A case of metastatic urinary bladder tumor from a gastric remnant carcinoma

We report a case of a metastatic urinary bladder tumor from gastric remnant carcinoma. On August 23, 1984, a 70-year-old-woman visited us with the complaint of dysuria. She had undergone gastrectomy for gastric ulcer 25 years earlier. Cystoscopy revealed a non-stalk tumor in the dome of the bladder and the examination of the upper gastro-intestinal tract revealed gastric remnant carcinoma. We treated her with adriamycin, cis-diamminedichloroplatinum and mitomycin C but unfortunately she died of cachexia two weeks later. An autopsy revealed that the urinary bladder tumor was a signet ring cell carcinoma, metastasized from gastric remnant carcinoma.     

A case of metastatic urinary bladder tumor from gastric carcinoma--especially mucohistochemical study

We report a case of metastatic bladder tumor from gastric cancer, which was difficult to differentiate from urachal tumor preoperatively, especially computed tomographic scan, cystoscopy, and biopsy. A 51-year old man visited our hospital with the chief complaint of asymptomatic gross hematuria. He had received subtotal gastrectomy for gastric cancer two years earlier. Because the possibility of urachal tumor could not be excluded, en bloc segmental resection of the bladder, the urachus, and the umbilicus was carried out. This case was diagnosed as adenocarcinoma histologically, but it was difficult to determine whether the case was a metastatic bladder tumor from gastric cancer or urachal tumor by the routine staining method. High iron diamine-alcian blue and paradoxical concanavalin A (ConA) stainings were performed, on the surgical specimens of this case and other urachal tumor already diagnosed. In these cases, metastatic bladder tumor could be differentiated from an urachal one by mucohistochemically paradoxical Con A staining. Seventeen cases of metastatic bladder tumor from gastric cancer including our cases were collected from the Japanese literature and reviewed.     

Metastatic bladder tumor from gastric carcinoma: a case report]

A 63-year-old man with a two-month history of nocturia and dysuria consulted his family doctor. As renal dysfunction and bilateral hydronephrosis were indicated, he was admitted to our hospital on November 28, 1988. Cystoscopy revealed a non-papillary and flat tumor from the ureteral orifice to the back wall of the bladder. A biopsy of the bladder wall revealed signet-ring cell carcinoma. A metastatic bladder tumor was suspected and laboratory tests of tumor markers showed a carcinoembryonic antigen value (CEA) of 1,000 ng/ml and CA19-9 of 12,210 U/ml. Upper gastrointestinal examination revealed carcinomatosis involving the stomach. A biopsy specimen of the stomach revealed the same pathological finding as the bladder wall. A metastatic bladder tumor was confirmed. The patient died of pulmonary emboli on December 11, 1988.     

A case of metastatic tumor of the spermatic cord from gastric carcinoma

A case of metastatic tumor of right spermatic cord in a 54-year-old man is reported. He visited our department with the complaint of a painless mass in right inguinal lesion. The initial diagnosis was a right spermatic cord tumor, and then orchiectomy was performed. Since pathological findings showed a poorly differentiated adenocarcinoma, further examinations were done, postoperatively. An upper gastrointestinal series revealed the presence of gastric carcinoma. Thus, these results suggested that the spermatic cord tumor was a metastatic lesion from the gastric carcinoma. Forty eight cases of metastatic tumor of the spermatic cord have been reported in our country. In 26 of these cases, gastric carcinoma metastasized to the spermatic cord.     

Small cell carcinoma of urinary bladder. A case report]

A 57-year-old male patient was admitted because of a severe lumbar pain and gross hematuria. The rectal examination revealed a fist-sized soft tissue mass in the small pelvic space. A huge non-papillary tumor, which occupied the intravesical space, was found on cystoscopic examination. CEA IAP, TPA, CA19-9 and NSE were abnormally elevated in the serum. The pelvic CT scan shown an enormous polypoid tumor arising from the anterior vesical wall, while no abnormal lesion was found in the head, neck, chest and abdominal CT scans. The bone scintigraphy revealed multiple abnormal accumulations. The transurethral biopsy of the tumor was carried out. The pathological examination revealed homogeneous and small tumor cells arranged in sheet and solid patterns, which were positive for the anti-NSE stain and anti-NF stain, but negative for Grimelius stain. The final diagnosis was small cell undifferentiated carcinoma of the urinary bladder. The patient died of cancer five months after diagnosis.     

A case of primary signet ring cell carcinoma in urinary bladder]

A case of primary signet ring cell carcinoma in the urinary bladder in a 50-year-old male is described. The patient with a complaint of urinary incontinence was admitted for invasive bladder carcinoma based on cystoscopic examination. The pathological specimen using transurethral resection-biopsy revealed signet ring cell carcinoma. In the preoperative work up, no obvious metastases were found. Following hospitalization, the patient's course gradually worsened with weight-loss, abdominal fullness and dysuria. The operation for total cystectomy was started, but was interrupted when the peritoneal cavity was found to be fully occupied with massive ascites, invasive lesions into nets and surrounding tissue. He died on November 19, 1986, approximately 7 months after onset of symptoms. An autopsy proved that the tumor which was pathologically identified as signet ring cell carcinoma, originated from the urinary bladder invading the perivesical tissues, and also into the intraabdominal space. We found 34 cases in the literature, originating from the urinary bladder. This case is considered to be the 35th. In conclusion, rapid total cystectomy following an early and definite diagnosis is the only procedure to treat such tumors.     

A case of urinary bladder hernia]

A 77-year-old male visited our hospital complaining of swelling in the right scrotal and inguinal region, urinary urgency and difficulty of urination. Physical examination revealed an elastic soft mass in the right inguinal region toward the right scrotum. Rectal examination proved that the prostate was moderately enlarged. Cystogram and urethrography showed hernia of the bladder into the right scrotum and benign prostatic hyperplasia. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. Transurethral resection of the prostate was done for benign prostatic hyperplasia. Later, surgical treatment for the bladder hernia was performed by replacing the bladder into the pelvic cavity and closing the hernial ring without resection of the bladder wall. The bladder hernia proved to be a para-peritoneal type. The postoperative course was uneventful. The previous reports of urinary bladder hernia are reviewed and the incidence, etiology, diagnosis the treatment are discussed.     

A case of metastatic choroid plexus tumor from cholangiocellular carcinoma

Metastatic intraventricular tumor located in the choroid plexus is very rare. Only a few cases have been reported in the past. According to past reports, these tumors originated from lung, colon, and so on, but not from the bile duct. This is the first case report of choroid plexus metastasis from cholangiocellular carcinoma. A 57-year-old woman who had a history of cholagiocellular carcinoma, demonstrated intraventricular tumor. Although sufficient examination was performed, the tumor was difficult to diagnose as being a metastatic tumor or a choroid plexus carcinoma. Because of this, we performed endoscopic biopsy of the intraventricular tumor. However intraoperative findings were not helpful in distinguishing metastatic tumor and choroid plexus carcinoma. Postoperatively, histological examination was performed. However it was still difficult to differentiate this rare tumor from choroid plexus carcinoma by only hematoxylin and eosin stain. For further examination, Ber EP-4 stain was performed. Ber EP-4 showed strongly positive which indicates metastatic tumor. This method led us to make an appropriate diagnosis of this extremely rare tumor. We considered that in order to diagnose this rare tumor, appropriate histopathological examination, including immunohistopathological examination should be performed.     

A case of prostatic carcinoma presenting as a metastatic orbital tumor]

A 66-year-old man presented with progressive proptosis of the left eye associated with ocular pain. A computed tomographic scan showed a high density mass in the posterolateral portion of the left orbit. The patient underwent surgical removal of the tumor and histopathological examination revealed adenocarcinoma of unknown origin. To find out the primary focus of the tumor the patient was referred to our department, where biopsy of the prostate revealed adenocarcinoma. Further, immunohistochemical examination of the orbital tumor was performed and prostatic acid phosphatase was identified. Finally, we made a diagnosis of orbital metastasis from prostatic carcinoma. This paper presents a rare case of prostatic carcinoma with orbital metastasis and reviews the literature of the subject.     

A case of neuroendocrine tumor of the urinary bladder

We present a case of a neuroendocrine tumor of the urinary bladder. A 81-year-old-man presented with macrohematuria and difficult voiding. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed non-papillary broad-based bladder tumor, benign prostatic hyperplasia and three bladder stones. Histological diagnosis was neuroendocrine tumor of the urinary bladder and he underwent two courses of trans-arterial infusion (neoadjuvant) chemotherapy. After two courses of chemotherapy, pelvic CT scan revealed partial response and then the patient underwent transurethral resection of the bladder tumor, simultaneously with TUR-P and cystolithotripsy. Examination of the resected specimen indicated pathological complete remission and he discharged. Although the patient was followed-up postoperatively because of pathological complete response, the tumor recurred in the bladder three months later.     

A case of paraganglioma of the urinary bladder]

A 50-year-old male was referred to our department because of dysuria. On cystoscopy, a submucosal bladder tumor was seen at the posterior wall of the urinary bladder. Transurethral resection was performed with no intraoperative complications. Histopathological diagnosis of paraganglioma was confirmed by immunohistochemical staining.     

A case of solitary metastatic lung tumor from follicular carcinoma of the thyroid in hemodialysis patient]

A 61-year-old female was admitted for abnormal shadow of chest X-ray film. The patient has been treated with hemodialysis for chronic renal failure since February 16, 1982, and was performed total thyroidectomy for follicular carcinoma of thyroid on October 24, 1989. Chest X-ray on September 8, 1994 showed the abnormal shadow of right lower lung, chest CT revealed tumor shadow which is suspected to malignancy. We performed partial resection of right lung including tumor on October 19, 1994. Histological examination certified the lung metastasis of follicular carcinoma of thyroid. Postoperative course has been uneventful and there has been no episode of recurrence for 3 years and half after the surgery. We reported this very few case with solitary metastatic lung tumor from follicular carcinoma of thyroid with a review of the literature.     

Pseudosarcomatous fibromyxoid tumor of the urinary bladder: a case report]

A 41-year-old man was referred to our clinic for gross hematuria. Cystoscopy revealed a 6 x 5 x 5 cm wide-based tumor located at the dome of the bladder. Pathological diagnosis of the biopsy was pseudosarcomatous fibromyxoid tumor. Microscopically this tumor was composed of spindle cells and myxoid stroma, and immunohistochemical and ultrastructural studies showed benign characteristics of this tumor. Therefore partial cystectomy was performed. It is important to recognize the histological characteristics of this essentially benign condition so that total cystectomy can be avoided.     

A case of metastatic tumor of spermatic cord from ascending colon carcinoma

A 75-year-old man presented with a left inguinal mass two months after surgery for ascending colon cancer. Physical examination revealed a solid mass in the left inguinal area. High orchiectomy was performed under the diagnosis of spermatic cord tumor. Gross examination of the specimen revealed a 5.0 X 3.2 X 3.0 cm tumor in the spermatic cord. Pathological examination of the tumor was reported as poorly differentiated adenocarcinoma with features similar to those of previously resected colon cancer. He developed peritonitis carcinomatosa and died 6 months after left orchiectomy. To our knowledge, a metastatic tumor of the spermatic cord from colon or rectal cancer is rare. As previously reported, the prognosis of this case was also poor.     

A case of metastatic tumor of spermatic cord from renal cell carcinoma

A 51-year-old man was admitted with the complaint of left scrotal swelling (11 x 5 x 5 cm). He had undergone left nephrectomy and removal of tumor thrombus in inferior vena cava due to renal cell carcinoma. Nine months after the nephrectomy, left scrotal enlargement was noticed. Left high orchiectomy was performed on January 20, 1988. A clear cell carcinoma was present in spermatic cord and pampiniform plexus histologically but testis and epididymis were intact. Renal cell carcinoma seemed to disseminate retrograde through the spermatic vein to spermatic cord. The metastatic tumor of spermatic cord from renal cell carcinoma is very rare and this case is the fifth case in the Japanese literature.     

A case of inflammatory myofibroblastic tumor of the urinary bladder

A 61 year-old man complaining of asymptomatic gross hematuria was admitted to our hospital in May 2005. Transurethral resection of bladder tumor (TUR-BT) was performed for a bladder tumor (urothelial carcinoma (UC), pTa, G2). The TUR-BT was performed again because cystoscopy revealed a nonpapillary bladder tumor on the posterior bladder wall in September 2007. The pathological findings showed a UC, pTa, G2 and an inflammatory myofibroblastic tumor (IMT), pT1. The TUR-BT was performed two more times for tumor recurrences. We considered a total cystectomy because of the possibility of a pathologically low grade sarcoma and the considerable enlargement of the tumor size for a month after the TUR-BT. Ultimately, a malignant sarcoma was not diagnosed from the pathological findings. We practiced conservative therapy with a steroid and the tumor was reduced.     

A case of metastatic tumor of spermatic cord with hydrocele from gastric cancer

A 70-year-old man, who had undergone total gastrectomy for Borrmann III gastric cancer one year previously, was referred to us with a complaint of left scrotal swelling. Physical examination showed left scrotal hydrocele and a hard nodule in the ipsilateral inguinal area. Excretory pyelography and abdominal computed tomography showed mild left hydronephrosis and no stone. A left orchiectomy was performed. The mass in the spermatic cord was 2.5 x 1.0 x 1.0 cm in size, and the pathological diagnosis was tubular adenocarcinoma, identical to that of the previous gastric cancer. Five months after orchiectomy, the patient underwent percutaneous nephrostomy to manage postrenal renal failure caused by massive metastasis of retroperitoneal lymph nodes. He died one month later. We found a total of 84 cases of metastatic tumors of the spermatic cord reported in Japan, approximately half of which were metastases from gastric cancer. In 10 cases, including ours, the tumor was accompanied by hydrocele of the scrotum or spermatic cord. Although this association is rare, cancerous lesions should be considered in the management of hydrocele.     

Small cell carcinoma of the urinary bladder: a case report]

We report a case of small cell carcinoma of the urinary bladder. A 60-year-old man with microscopic hematuria was referred to our hospital. Cystoscopy revealed a sessile tumor on the left lateral wall of the urinary bladder. The patient underwent transurethral resection of the bladder tumor (TUR-Bt). Because of muscle invasion (pT2), total cystectomy was recommended, but was not performed because the patient would not give consent for the operation. Six months after TUR-Bt, invasive bladder tumor recurred and total cystectomy was performed. Pathological examination of the operative specimen revealed small cell carcinoma. Adjuvant combined therapy of irradiation and chemotherapy (nedaplatin and etoposide) was ineffective. Metastases to retroperitoneal lymph nodes, lung and liver were detected soon after the adjuvant therapy. The patient died 15 months after his first visit to our hospital.     

A case report of sarcomatoid carcinoma of the urinary bladder

A 49-year-old female visited to our department with complaints of gross hematuria and micturition pain. Cystoscopic examination revealed a 5-cm diameter solid broad-based tumor located at the front wall of the bladder. Histologically, the tumor was composed of grade 2 urothelial carcinoma (UC) element and sarcomatous spindle cell element. Immunohistochemical examination demonstrated that both UC and spindle cells were positive for cytokeratin. In addition, spindle cells did not stain for S-100 protein or smooth muscle actin. We diagnosed the tumor as sarcomatoid carcinoma and performed total cystectomy and ileal conduit without chemotherapy and radiation. The patient has remained without any evidence of recurrence for 14 months after operation. Sarcomatoid carcinoma of the bladder has aggressive malignant potential and poor prognosis. An appropriate adjuvant therapy for sarcomatoid carcinoma with metastasis has not been established. Total cystectomy is recommended as soon as possible after pathological diagnosis in the same manner as conventional high grade UC.     

A case of signet-ring cell carcinoma of the urinary bladder

Signet-ring cell carcinoma of the urinary bladder is a rare disease. A 78-year-old man was admitted to our hospital on March 18, 1988 with the complaints of microhematuria and pollakisuria. Cystoscopic examination revealed non-papillary tumor at the dome of the bladder. partial cystectomy was done under epidural anesthesia. Pathological findings revealed signet-ring cell carcinoma. The gastrointestinal, respiratory and genitourinary tracts were examined but no other tumor lesions could be found. The postoperative course was uneventful, and chemotherapy such as biological response modifier was administered. However, the patient died of heart failure on July 14, 1988. This is the sixtieth case reported in the literature.