Small cell carcinoma of the urinary bladder treated with neo-adjuvant cp chemotherapy (CPT-11 and CDDP): a case report

We report a cases of primary small cell carcinoma of the urinary bladder. A 68-year-old man was referred to our hospital because of asymptomatic gross hematuria. Cystoscopy showed a solid tumor on the dome of the urinary bladder. Pelvic magnetic resonance imaging (MRI) revealed a mass lesion with extravesical extention, and computed tomography(CT) scan and bone scintigraphy showed no distant metastasis. Transurethral resection of the bladder tumor (TUR-BT) was performed. Histopathological findings of the specimen showed small cell carcinoma (> pT2), with transitional cell carcinoma (TCC), grade 2-3. We performed one course of neoadjuvant CP chemotherapy using Irinotecan (CPT-11) and Cisplatin (CDDP), followed by radical cystectomy. Histopathological finding of the specimen showed no evidence of malignancy. We performed one more course of adjuvant CP chemotherapy. He has been free of disease 7 months after operation.     

A young patient with invasive small cell carcinoma of the urinary bladder: a case report

A 29-year-old woman with gross hematuria was referred to our hospital. Cystoscopy revealed a nonpapillary broad-based tumor on the right lateral wall of the urinary bladder, which a transurethral biopsy identified as transitional cell carcinoma (G2). CT and MRI suggested that the carcinoma invaded beyond the bladder wall. We performed a radical cystectomy with hysterectomy and the construction of an ileal neobladder. Pathological examination of the specimen indicated that it was small-cell undifferentiated carcinoma at the stage of pT2bpN0. For adjuvant chemotherapy, four cycles of CPT-11 and CDDP chemotherapy were performed, which is currently the usual chemotherapy for small-cell lung carcinoma in Japan. The patient is alive without any evidence of tumor recurrence at 12 months after surgery.     

A case of bladder metastasis of renal cell carcinoma: a case report and literature review

The patient was a 74-year-old man. Computed tomography (CT) detected a right renal tumor with paraaortic lymph node swelling. Radical nephrectomy and left lymphadenectomy were performed in September 2008. Interferon-alpha (6 million international units three times per week) was administered as adjuvant therapy. Due to the development of side effects, including fatigue, the patient's immunotherapy was discontinued after 6 months. Radiofrequency ablation for pulmonary metastasis was performed 9 months after surgery. A nodular pedunculated tumor was detected on the posterior wall of the urinary bladder by CT, and transurethral resection was performed 18 months after nephrectomy/lymphadenectomy. Since the pathological diagnosis of the bladder tumor was clear cell carcinoma, that tumor was thought to have originated from the renal cell carcinoma. We have summarized 43 cases of bladder metastasis of renal cell carcinoma in Japanese patients, including ours.     

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.     

Small cell carcinoma of the urinary bladder with synchronous esophageal cancer and incidental lung cancer: a case report]

We present a case of triple primary cancers occurring synchronously in the urinary bladder, esophagus, and incidentally in the lung. A 65-year-old man with a chief complaint of gross hematuria was admitted to our hospital. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was transitional cell carcinoma of the urinary bladder and he underwent one course of neoadjuvant chemotherapy (M-VAC) with the preoperative diagnosis of T3bN0M0. After one course of chemotherapy, chest CT, lymph node biopsy and esophagoscopy revealed squamous cell carcinoma of the esophagus. He first underwent radiochemotherapy (total 70 Gy, CDDP 5 mg x 41, 5-FU 250 mg x 24) for esophageal cancer and achieved complete remission. Then, he underwent radiotherapy for a total of 60 Gy for bladder cancer. However, his general condition gradually became worse and he died from metastatic cancer. The autopsy proved that he died from multiple metastases of small cell carcinoma of the urinary bladder and incidentally squamous cell carcinoma of the lung was identified.     

Bladder metastasis of renal cell carcinoma : report of a case

A 65-year-old man presented with gross hematuria in 2004. Computed tomography (CT) showed a left renal mass, and he underwent laparoscopic radical nephrectomy. Pathological diagnosis was clear cell carcinoma (pT2N0M0, G2＞G3). Four years later, a right adrenal tumor was disclosed by follow-up CT. Then laparoscopic adrenectomy was performed. Histology showed metastasis of the renal clear cell carcinoma. In 2009, he noticed gross hematuria, and cystoscopy revealed a 2cm solitary, non-papillary tumor at the anterior wall of the bladder. At the same time, small solitary liver metastasis (6 mm) was observed on abdominal CT. Transurethral resection of the bladder tumor and resection of liver tumor was performed, and pathological diagnosis was clear cell carcinoma both in vesical and hepatic masses. Nine months after the last surgery, he is living with no obvious tumor recurrence. To our knowledge this case is the 34th case of bladder metastasis from renal cell carcinoma in the Japanese literature. We reviewed literature and discuss the clinical features of bladder metastasis of renal cell carcinoma.     

Intra-arterial infusion chemotherapy for liver metastases of testicular tumors: report of two cases

Two cases of testicular tumors with lymph node involvement and multiple lung and liver metastases were treated successfully with intra-arterial infusion chemotherapy. Case 1: A 30-year-old man presented with right scrotal swelling and an abdominal mass. He had a large retroperitoneal mass and multiple lung and liver metastases on computed tomographic (CT) scan and chest X-ray. Right inguinal orchiectomy was performed. Histopathological diagnosis revealed embryonal cell carcinoma and choriocarcinoma. Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was started and repeated for 2 courses. The retroperitoneal mass and lung tumors decreased in size, but liver tumors enlarged. Systemic and intrahepatic arterial infusion combined with chemotherapy was administered, and intra-arterial chemotherapy (cisplatin, VP-16) was added. The patient also received systemic chemotherapy (carboplatin, VP-16, ifosfamide). After chemotherapy, retroperitoneal lymph node dissection was performed. Microscopic examination revealed no viable cancer cells. On CT scan, no retroperitoneal, liver, or lung tumor was detected. Case 2: A 43-year-old man presented with right scrotal swelling and an abdominal mass. CT scan revealed a large retroperitoneal mass as well as lung and multiple liver metastases. Right inguinal orchiectomy was performed. Histopathological diagnosis revealed seminoma. Cisplatin, vinblastine, VP-16 and pepleomycin combination chemotherapy (PVeBV) was administered, but the liver tumors ware enlarged on CT scan. Intrahepatic arterial infusion chemotherapy (cisplatin, VP-16) was started and repeated for 4 courses. On CT scan, the lung metastasis seemed to have disappeared, and the retroperitoneal mass and liver metastases were decreased in size.     

A case involving long-term survival after esophageal cancer with liver and lung metastases treated by multidisciplinary therapy: report of a case

A 57-year-old male with lower esophageal cancer underwent subtotal esophagectomy with lymphadenectomy. The histopathological diagnosis was poorly differentiated squamous cell carcinoma, pT2N1M0 pStageIIB. After one course of postoperative adjuvant chemotherapy involving low-dose CDDP/5FU, a PET–CT scan obtained 12 months after surgery revealed a solitary liver metastasis in the S2 area. The patient then underwent five courses of docetaxel chemotherapy (80 mg/body, tri-weekly), and a partial response was observed. We also performed radiofrequency ablation (RFA), after which a complete response was observed. Twenty months after surgery, we detected local liver recurrence in the same position and performed additional RFA. Twenty-four months after surgery, a solitary lung metastasis was detected in the left S2 area and the patient was administered five additional courses of docetaxel therapy. Subsequently, PET–CT revealed growth of lung and liver tumors without recurrence in other areas. Twenty-nine months after surgery, we partially excised metastatic liver and lung tumors, and no subsequent recurrence has since been detected. The prognoses of patients who suffer from esophageal cancer organ recurrence are known to be extremely poor, and optimal therapeutic strategies for treating these patients have not been established. This long-term survival case suggests that multidisciplinary therapy for the treatment of liver and lung recurrence after esophagectomy is effective.     

Early stage small cell carcinoma of the urinary bladder

A 73-year-old man with primary small cell carcinoma of the bladder underwent radical cystectomy. The pathological findings revealed the tumor confined to the submucosal layer (pT1) without metastasis. No adjuvant chemotherapy was carried out. He is alive with no evidence of the disease 24 months after the operation.     

Carcinomatous meningitis from urothelial carcinoma of bladder and ureter: case report

Carcinomatous meningitis from urothelial carcinoma of the bladder and ureter is rare. A 77-year-old man with invasive bladder cancer and right ureter cancer had been treated with 3 courses M-VAC (methotrexate, vinblastine, epirubicin, cisplatin) chemotherapy. After chemotherapy we performed radical cystectomy and right nephroureterectomy (ileal-neobladder) (TCC, G3, pT3, N0, M0). Sixteen months after operation, patient complained of anorexia, muscular weakness, stiff neck. CT of chest and abdomen, and bone scintigraphy showed no metastasis. Brain CT and MRI showed hydrocephalus but no evidence of parenchymal metastasis. Because we suspected carcinomatous meningitis, we performed lumbar puncture. Cerebrospinal fluid cytology revealed class V (urothelial carcinoma). Patient died 6 days after diagnosis of carcinomatous meningitis.     

Small cell carcinoma of the bladder. Small cell lung cancer-associated ganglioside (Fuc GM1) expression]

A 61-year-old male visited us with chief complaints of macroscopic hematuria and bladder irritation symptoms. Cystoscope, U/S, MRI, and CT showed an extensive non-papillary, wide-based tumor centering around the anterior wall of the bladder. Transabdominal U/S-guided full-thickness biopsy indicated a pT3a (Biopsy) primary small cell carcinoma of the bladder containing neuroendocrine granules. Immunohistochemical studies revealed Fuc GM1, an antigen related to small cell carcinoma of the lung. Neoadjuvant therapy consisted of preoperative irradiation at 50 Gy and intra-arterial infusion chemotherapy with CDDP and THP. Since a follow-up full thickness biopsy indicated pT0 (Biopsy), total cystectomy was performed. Examination of the resected specimen also indicated pathological CR.     

Long-term survival and onset of granulomatous pneumonia after lung metastasectomy in a patient with non-muscle-invasive bladder cancer

Aims

This case report describes a first case of granulomatous pneumonia occurring at the same site of the previous lung metastasectomy in a patient with high-grade non-muscle-invasive bladder cancer (NMIBC), which was treated with bladder preservation therapy despite multiple recurrences and failure of intravesical bacillus Calmette-Gu?rin (BCG) therapy.

Clinical case

We report a 52-year-old woman who underwent transurethral surgery and BCG therapy for pT1, G3 bladder cancer. Although cystectomy was recommended after BCG failure, the operation was not performed because of the patient??s wish for bladder preservation. Eighteen months after the first surgery, computed tomography (CT) revealed solitary lung mass. Partial lobectomy which the patient underwent after chemotherapy revealed G3 metastatic urothelial carcinoma. Three years after lung metastasectomy, CT revealed lung mass at the same site of the previous lung metastasectomy. Dynamic contrast-enhanced magnetic resonance imaging showed the significantly enhanced lung mass, which indicated lung metastasis. However, lobectomy of the remnant lobe revealed that the lung mass was granulomatous pneumonia. Although no additional specific treatment was carried out, the patient remains free of disease for 53?months after surgery.

Conclusions

Lung metastasis from NMIBC rarely occurs. Our case report confirms that lung metastasectomy in highly selected patients may contribute to long-term disease control. Moreover, our case report suggests that mycobacterial lung infections along the staple-suture line rarely occur, and percutaneous biopsy should be considered under these circumstances to avoid the unnecessary operation.     

Collecting duct carcinoma producing granulocyte-colony-stimulating factor (G-CSF)

We present a 67-year-old male with a rare case of collecting duct carcinoma producing granulocyte colony-stimulating factor. He was referred to us with lumbago and fever. Laboratory testing showed leukocytosis and computed tomography revealed a left renal mass. After chemotherapy with gemcitabine and nedaplatin, computed tomography showed a partial response. A left nephroureterectomy was performed. The histopathological diagnosis was collecting duct carcinoma producing granulocyte-colony-stimulating factor. White blood cell levels were reduced to 9900/mm(3). No recurrence was detected after completion of adjuvant chemotherapy and the patient was discharged from the hospital. However, 3 months later, computed tomography revealed multiple lung metastasis. Nedaplatin- based chemotherapy was administered but computed tomography after chemotherapy identified a progressive disease. The patient died 9 months after the operation.     

Small cell carcinoma of the urinary bladder: a case of remarkable remission with combined chemotherapy

A 67-year-old man presented with asymptomatic gross hematuria. Cystoscopy and radiographic studies revealed a large tumor on the left lateral wall of the urinary bladder. Also, computer tomographic (CT) scan of the pelvic cavity showed metastasis to the left external iliac node. The light microscopic appearance of cold punch biopsy specimens for the tumor was closely akin to small cell carcinoma of the lung. Ultrastructurally, the tumor cells exhibited small numbers of neurosecretory granules in the cytoplasm. After surgical treatment, the patient was treated with combined chemotherapy using cis-diamminedichloroplatinum (CDDP) and etoposide. On CT scan, a remarkable remission was shown to have been induced at the metastatic site after three cycles of the therapy. Though the morphology of bladder tumors has not received very much attention, this report emphasizes that detailed pathological examination is of therapeutic importance.     

Bladder recurrence of renal cell carcinoma: report of two cases

We present two rare cases with renal cell carcinoma which recurred at urinary bladder. The first case is an 87-year-old female who had been undertaken right nephrectomy 17 years earlier. Through the examination of hypercalcemia, bone metastases and a bladder tumor were found. Transurethral resection of the bladder tumor was performed and histological examination revealed that the tumor was clear cell carcinoma similar to the right renal tumor. The second case is a 67-year-old male who had been undertaken left nephrectomy 4 and half years earlier. In spite of the adjuvant immunotherapy including interferon alpha, gamma and interleukin-2, 16 months later multiple lung metastases appeared. One month before admission he noticed asymptomatic hematuria. Cystoscopy revealed 3 non-papillary pedunculated tumors, which were resected transurethrally. Histologically the tumor was clear cell carcinoma similar to the left renal tumor. In both cases the metastasis was confirmed histologically. As in both cases the recurrent bladder cancers were confined in the mucosa, these metastases were thought to be caused by implantation.     

Bladder cancer with skin metastasis: a case report

Bladder carcinoma with skin metastasis is extremely rare. We herein report a case of a bladder tumor with skin metastasis. A 68-year-old man was referred to our hospital with macroscopic hematuria. Cystoscopy revealed a trigone papillary tumor. Transurethral resection of bladder tumor (TURBT) was performed and the pathological diagnosis was transitional cell carcinoma (TCC), pT1, G3. Thereafter, he received several courses of TURBT, intravesical chemotherapy (pirarubicin, bacillus Calmette-Guerin and mitomycin C) and intra-arterial chemotherapy because of recurrence. Thirteen years later, he underwent total cystoprostatectomy with neobladder formation. Histological examination revealed muscle-invasive bladder cancer with a staging of T3bNOM0. Two years and three months later, multiple firm nodules with eruptions appeared on the skin in several regions; they were resected and the histological findings revealed TCC. This indicated metastatic spread from the primary bladder TCC. He received only supportive treatment during this period due to renal dysfunction. He died four months after the manifestation of the skin metastasis due to multiple metastases.     

Testicular metastasis from squamous cell carcinoma of the lung

We present a case of squamous cell carcinoma of the testis that metastasized from lung cancer. The patient, who had received left pneumonectomy 2 years earlier for squamous cell carcinoma (SCC) of the lung, developed pulmonary metastasis, which was treated with chemotherapy. Although the recurrence regressed after treatment, the testicular tumor progressed gradually. Left radical orchiectomy was performed. Pathological examination revealed metastatic SCC. Testicular metastasis from lung cancer is a very rare disease.     

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.     

Small cell carcinoma of the urinary bladder: a case report

We report a case of small cell carcinoma of the urinary bladder. The patient was a 58-year-old man complaining of gross hematuria. Clinical examination revealed a non-papillary, broad-based tumor on the right bladder wall with a clinical stage of T3a, N0, M0. Neoadjuvant intraarterial infusion chemotherapy with methotrexate, adriamycin and cisplatin was performed, but it was ineffective. Three weeks later we performed a radical cystectomy. The operative specimen of the tumor revealed small cell carcinoma. It was staged pT3aN0M0R0L2V1. Postoperatively, 1 course of adjuvant chemotherapy using cisplatin and etoposide was performed. The patient is alive without any evidence of tumor recurrence at 6 months after operation.     

Primary small cell carcinoma of the bladder in which the bladder preservation was achieved by chemotherapy and transurethral resection

A 78-year-old man was referred to our hospital for asymptomatic gross hematuria on April 16, 2007. Cystoscopy and abdominal computed tomography revealed a nonpapillary tumor at the upper area of the bladder. Abdominal and thoracic computed tomography showed no lymph nodes and no metastasis to other organs. Transurethral resection of bladder tumor (TURBT) was performed, and a pathological diagnosis of small cell carcinoma of the bladder at stage pT2N0M0 was made. Considering the patient's age and the location of the tumor, we administered chemotherapy using carboplatin and etoposide after resection of the tumor. After 2 courses of chemotherapy, a second-look TURBT was performed, and pathological examination showed no viable tumor cells. Cystoscopy performed after 3 months revealed recurrence of a nonpapillary tumor at a different area of the bladder. We performed TURBT and made a pathological diagnosis of small cell carcinoma of the bladder at stage pT1N0M0. The patient was free from disease in January 2011.