A case of metastatic urinary bladder tumor from gastric carcinoma]

We report a case of metastatic bladder tumor from gastric carcinoma. A 55-year old male patient was referred to our urological clinic with a complaint of frequent urination and voiding pain. He had undergone total gastrectomy for poorly differentiated adenocarcinoma, signet-ring cell type, 9 months earlier. Computed tomographic scan revealed a thick bladder and rectum wall all around. Punch biopsies from vesical and rectal wall revealed metastatic adenocarcinoma, signet-ring cell type. There were no other metastatic sites. Systemic chemotherapy was done with a combination of mitomycin-C, 5-fluorouracil and cytosine arabinoside. This chemotherapy was effective and complete remission was obtained at bladder and rectum. Six months after chemotherapy, peritoneal recurrence developed and he died 9 months after chemotherapy. However no recurrence of bladder tumor was detected. This was a quite rare case of metastatic bladder tumor characterized by good response to systemic chemotherapy.     

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.     

An unusual cause of irritable urinary bladder symptoms

A metastasis from a renal cell carcinoma to a seminal vesicle is extremely rare. This pattern of metastatic disease has been reported once previously in the Japanese literature. We describe a patient with irritability symptoms of the urine bladder and involuntary loss of stool caused by obstruction of the bladder by a large metastasis from a renal cell carcinoma to the seminal vesicle. The mode of diagnosis and treatment of this patient are described.     

Renal cell carcinoma metastasizing to choroid plexus of lateral ventricle; a case report]

A rare case of renal cell carcinoma metastasizing to the choroid plexus of the lateral ventricle is reported. A 59-year-old woman was admitted to our institution on November 26, 1987 complaining of left-half headache for one month. She had a past history of right nephrectomy due to renal cell carcinoma 4 years before admission, and of right radical mastectomy due to breast cancer 10 years before admission. She had no abnormal neurological findings and laboratory results were normal. CT scan revealed a well-circumscribed, apparently homogeneously enhancing mass in the left lateral ventricle with mild ventricular dilatation. Left vertebral angiogram showed a tumor stain fed by the left posterior choroidal artery. The most likely diagnosis was thought to be metastasis of renal cell carcinoma. The patient underwent the operation for tumor removal via the posterior interhemispheric transcallosal approach 14 days after admission. A histological examination of the tumor determined the diagnosis of clear-cell type renal cell carcinoma. The operation was uneventful and the patient was discharged 20 days after operation without neurological deficit. But she had recent-memory disturbance, low activity, and gait disturbance in May 1989. CT scan revealed ventricular dilatation and tumor recurrence at the same site. She also suffered from diabetes due to the regrowth and invasion of primary tumor to the pancreas. She was discharged free of neurological defects after ventriculo-peritoneal shunt. In December 1989, she gradually deteriorated due to the regrowth of the intraventricular metastatic lesion, and now she is bedridden. Choroid plexus metastasis is quite rare, and, to our knowledge, only three cases have been described.     

Bone metastases as the initial presentation of carcinoma of gall bladder: a rarity

Distant metastases are rare form of presentation of carcinoma gall bladder. Bony pain as initial presentation is quite unusual. A 50-year-old woman presented with the pain in right shoulder. Investigation showed metastatic adenocarcinoma in the head of humerus and the primary was found in the gall bladder. She received local radiotherapy for bone metastases and undergoing systemic chemotherapy. Carcinoma gall bladder is a common abdominal malignancy, mostly presenting in advanced stage with abdominal symptoms and obstructive jaundice. In presence of metastasis, the management is palliative and role of chemotherapy is limited for palliation symptoms.     

Metastatic brain tumor originating from urachal carcinoma: case report

The authors presented a patient with metastatic brain tumor originating from urachal carcinoma. A 64-year-old female was admitted to our hospital with complaints of memory disturbance, indifference and apathy of 3 months duration. Head CT and MRI on admission showed a round mass with perifocal edema in the right frontal lobe. After administration of Gd-DTPA, the mass lesion showed ringed enhancement effect. Pelvic MRI scan revealed a bladder tumor, which was diagnosed as urachal carcinoma. The brain lesion was suspected to have metasta sized metastatic from urachal carcinoma, and was excised by craniotomy. Histology of the brain tumor was identical to that of urachal carcinoma. Postoperatively the patient received local radiation therapy, but died of multiple metastasis to lung and local recurrence, 18 months later. Urachal carcinoma is an extremely rare tumor, comprising 0.17-0.34% of all bladder tumors. Though this rare tumor carries a poor prognosis, it may be effective for longer survival of a patient to treat the metastatic brain lesion with surgery and radiation.     

Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the urinary bladder associated with left renal pelvic carcinoma: a case report

We report a case of primary mucosa-associated lympoid tissue (MALT) lymphoma of the urinary bladder associated with left renal pelvic carcinoma. A 84-year-old woman showed microscopic hematuria during follow up for hypertention. Left renal pelvic tumor was found and she was referred to our hospital for further evaluation and managemant. She showed pyuria and Escherichia coli was detected by urine culture. Intravenous pyelography and computed tomography revealed the left renal pelvic tumor and solid bladder tumor. Transurethral resection of bladder tumor and left total nephroureterectomy were performed. Histologically, the left renal pelvic tumor was urothelial carcinoma > > adenocarcinoma, G2, pT2 and the bladder tumor was MALT lymphoma. Ga-scintigraphy showed no hot uptake suspicious of metastatic lesion. Then, external beam radiotherapy (36 Gy) was performed to the urinary bladder. She has been alive for 14 months with neither renal pelvic tumor nor MALT lymphoma showing any evidence of disease progression.     

Mesonephric adenocarcinoma of the urinary bladder: a case report

We report a very rare case of mesonephric adenocarcinoma of the urinary bladder, the origin of which is still uncertain. A non-papillary and broad-based tumor was located in the trigone and bladder neck on cystoscopic examination. Pelvic magnetic resonance imaging in T2-weighted images revealed a mass invading into the muscular layer of the bladder wall. Histologic examination of bladder cup-biopsy specimens showed adenocarcinoma. She underwent total cystectomy and pelvic lymph node dissection. Histologically, the tumor was chiefly composed of cells with eosinophilic cytoplasm and partly of cells with clear cytoplasm or hobnail-shaped cells, arranged in tubular or papillary structures, and infiltrated peri-vesical fat tissues. She died of metastatic disease 22 months after surgery. To the best of our knowledge, the present case is the 19th reported in the literature.     

Sarcomatoid carcinoma of the urinary bladder in a hemodialysis patient: a case report

The following is a case report bladder of sarcomatoid carcinoma in a Japanese 65-year old female patient treated with hemodialysis. She developed chronic renal failure due to chronic glomerulonephritis. Fifteen months after the beginning of the hemodialysis, continuous gross hematuria was noticed, and cystoscopy revealed a broad-based bladder tumor spreading from the right lateral wall to the posterior wall. The histopathologic diagnosis of the TUR-Bt specimens was sarcoma. Radical cystectomy was performed under the diagnosis clinical stage III, T3bN0M0. The post-operative histopathologic diagnosis of the tumor was sarcomatoid carcinoma, composed of nests of transitional cell carcinoma (G 3) and predominant areas of spindle cell sarcomatoid transformation. Sarcomatoid carcinoma of the bladder in a hemodialysis patient is extremely rare, and to date this may be only the second case in Japanese medical literature.     

Brain metastasis of bladder carcinoma after total cystectomy: a case report

A 74-year-old woman underwent total cystectomy with ureterostomy on March 1993 on a diagnosis of advanced bladder cancer. The pathological diagnosis was transitional carcinoma grade 3, pT3a pN0 pV1, pL2. Two courses of adjuvant chemotherapy with CDDP and MTX were added. Three years and 3 months later, she began to suffer from amnesia and hemiparalysis on her left side. Brain MRI examination revealed a solid tumor, 4 x 4 x 3 cm in size, in the right frontal lobe of the cerebrum. No other metastatic lesions were found. She underwent surgical resection of the tumor and subsequent irradiation to right frontal lobe in the cerebrum. Pathological examination confirmed its origin of bladder cancer. She has been enjoying a disease-free life for 3 years with minimal neurological symptoms.     

A case study with bladder metastasis of renal cell carcinoma and stomach cancer

A 64-year-old woman received nephrectomy and lymph expurgation surgery for renal cell carcinoma on Jury 1, 1981. The pathologic diagnosis was adenocarcinoma of the clear cell type at Robson's stage 2. She next visited the Department of Gastroenterology complaining of stomach discomfort on November 5, 1981. Stomach cancer of Borrmann's type IV was identified in the lesser gastric curvature, but only biopsy was performed because it was inoperable. The pathologic diagnosis was undifferentiated adenocarcinoma. On January 23, 1982, there was microscopic hematuria. A cystoscopic examination revealed one soy bean-sized, smooth, pedicle tumor to which coagula were partially adhered in the center of the triangular region. After TUR-Bt performed on March 3 the pathologic diagnosis was adenocarcinoma of the clear cell type with no submucosal infiltration. Based on these findings, the patient was diagnosed as having suffered metastasis of renal cell carcinoma to the bladder. She died of bleeding from stomach cancer on June 15. Based on the fact that the tumor was localized in the bladder mucosa, implantation through the urinary tract was strongly suspected as the metastatic route of the renal cell carcinoma to the bladder.     

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.     

Metastasis of squamous cell carcinoma of the bladder to the heart: case report and review of the literature

A 79-year-old woman with no previous history of genitourinary disease presented to an outside urologist with gross hematuria and irritative voiding symptoms. Cystoscopy revealed a papillary bladder mass thought initially to represent urothelial carcinoma of the bladder with squamous features. The patient presented to our hospital 6 months later with dyspnea and edema. Computed tomography of the chest revealed a cardiac mass, and endomyocardial biopsy revealed metastatic squamous cell carcinoma. A review of the patient's pathology report confirmed the very rare diagnosis of metastatic squamous cell carcinoma of the bladder to the heart.     

泌尿系统肉瘤样癌和癌肉瘤八例报告并文献复习

目的 探讨泌尿系统肉瘤样癌和癌肉瘤的组织学特点、临床表现、治疗和预后.方法 泌尿系统肉瘤样癌和癌肉瘤8例.其中膀胱肉瘤样癌4例,男3例,女1例,年龄58、63、78、79岁,均因无痛性肉眼血尿就诊,肿瘤直径平均4.5(1.5～6.7)cm,为不规则、广基的浸润性肿物.行膀胱部分切除术2例,TURBt 1例,膀胱癌根治术1例.肾肉瘤样癌1例,男,64岁,因肉眼血尿就诊,伴同侧肾上腺和胰腺转移,行肾癌根治术和胰腺体尾切除术.转移性右肾上腺肉瘤样癌1例,男,47岁,原发灶为左肺肉瘤样癌,行左肺下叶和右肾上腺切除术.肾盂癌肉瘤1例,女,64岁,表现为无痛性肉眼血尿,行左肾、输尿管及部分膀胱切除术.膀胱癌肉瘤1例,男,77岁,无痛性肉眼血尿,肿瘤直径2.5～3.0 cm,行TURBt术.8例均经病理检查确诊.8例均获随访,随访时间36～96个月.结果 膀胱肉瘤样癌4例中:1例G_3、T_(2a)者行TURBt,术后行丝裂霉素膀胱灌注化疗,随访96个月无瘤生存;1例63岁女性先行TURBt,术后病理为肉瘤样癌、T_1伴有原位癌(T_m),1个月后行膀胱癌根治切除术.随访36个月无瘤生存;1例T3a者行膀胱部分切除术,术后辅以放疗,随访36个月无瘤生存;1例T4a者行姑息性膀胱部分切除术,术后病理切缘阳性,术后2个月死于肿瘤多脏器转移.肾肉瘤样癌患者术后2个月开始化疗(盐酸吉西他滨加卡铂),又出现肝、肺转移,术后5个月死亡.转移性右肾上腺肉瘤样癌患者术后在外院行3个疗程化疗(顺铂加依托泊苷),5个月后出现左肾上腺转移,术后7个月死亡.肾盂癌肉瘤患者的肿瘤以软骨肉瘤为主,伴少许鳞状细胞癌及未分化癌,随访60个月无瘤生存.膀胱癌肉瘤患者肿瘤病理分期为T2a,主要是平滑肌肉瘤,伴有鳞状细胞痛和腺癌,术后予以全身化疗(盐酸吉西他滨加卡铂),随访12个月死于慢性阻塞性肺气肿、肺部感染.结论 泌尿系统肉瘤样癌和癌肉瘤少见,多见于老年男性,恶性程度高,浸润性强,预后差.肿瘤的病理分期和治疗是影响预后的因素,早期诊断和积极的综合治疗可望获得较好的治疗结果、延长患者生存期.     

Case report: a case with small cell carcinoma of the bladder transformed from urothelial carcinoma

A 69 year-old woman visited our hospital with a chief complaint of macrohematuria in April 2004. She was diagnosed with bladder tumor. She underwent transurethral resection ofbladdar tumor three times and right partial ureterectomy for ureteral tumor following primary bladder carcinoma. All pathological findings demonstrated that the tumor was urothelial carcinoma (UC), G1-G2, pT1 including right ureteral tumor. In spite of intravesical instillation of BCG, recurrent invasive bladder tumor was found in June 2006. In July 2006, we performed total cystectomy and construction of ileal conduit. Surgical specimen revealed small cell carcinoma and immunohistochemical staining with NSE and synaptophysin was positive. On day 67 after operation, the patient died of multiple metastases to liver and bone.     

Skeletal muscle metastases from urothelial cell carcinoma

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.     

Metastatic hepatocellular carcinoma obstructing the right ventricular outflow tract.

A 49-year-old female with a past history of liver resection due to hepatocellular carcinoma was referred to our Department for treatment of a metastatic cardiac tumor obstructing the right ventricular outflow tract. She underwent operation twice with cardiopulmonary bypass, and symptoms were relieved. Metastasis from hepatocellular carcinoma to the heart is very rare, but should be taken into consideration during follow-up after treatment for a primary liver tumor.     

Solitary metastasis to the urinary bladder from renal cell carcinoma: a case report

A 48-year-old woman was referred to our hospital with a bladder mass which was detected by a general practitioner. Ultrasonography showed a small bladder tumor and right renal mass. Cystoscopy revealed a solitary, non papillary tumor at the right side of the retro-trigone. Computed tomography revealed a large tumor at the right kidney. Transurethral resection of the bladder tumor was performed. The histopathological diagnosis was clear cell carcinoma. There was no other distant metastasis. Sequentially, radical nephrectomy was performed. Histopathologically, the right renal tumor showed clear cell carcinoma. This was considered to be a case of a solitary metastatic bladder tumor from renal cell carcinoma.     

Bilateral ureteral tumors associated with chronic renal failure: a case report

A 66-year-old female with bilateral ureteral tumors associated with chronic renal failure is presented. She received pan-hysterectomy due to uterine cancer in 1957. She was first referred to our clinic to make internal shunt under a diagnosis of chronic renal failure. In 1979, the diagnosis of neurogenic bladder and bilateral vesicoureteral reflux (rt; grade 3, lt; grade 1) was made. She was admitted to our clinic with complaints of macroscopic hematuria and a temperature of 39 degrees C on April 28, 1983. Cystoscopically, pyuria from the right ureteral orifice was found. Right retrograde pyelography revealed severe dilatation of the right ureter and renal pelvis with some filling defects. For drainage of pus retaining in the right renal pelvis, right percutaneous nephrostomy was made under the guidance of ultrasonography. After her general condition improved, right nephroureterectomy was performed under the diagnosis of right pyonephrosis on June 8, 1983. Right pyelonephritis and right ureteral tumor, grade 3, were pathologically demonstrated. After the operation, an invasive bladder tumor was detected on cystoscopy and ultrasonography, subsequently a total of 3,900 rad irradiation was given to the bladder tumor. She died of pulmonary edema 7 months later. Autopsy demonstrated a transitional carcinoma, grade 3, of the left ureter. Bilateral urothelial tumors of the upper urinary tract is rare, and to our knowledge only 29 cases have been reported in Japan.     

A case of primary transitional cell carcinoma of the prostate]

We report a rare case of primary transitional cell carcinoma of the prostate. A 66-year-old man was referred to our hospital with the chief complaints of pollakisuria and residual urine sensation on January 21, 1998. Under a preoperative diagnosis of benign prostatic hyperplasia, transurethral resection of the prostate was performed. Histopathological examination revealed grade 3 transitional cell carcinoma. Then the transrectal needle biopsy of the prostate and random biopsy of the urinary bladder were performed. Since no metastatic tumors or tumor cells were detected in either the prostate or urinary bladder or any other organs, this patient was diagnosed with primary transitional cell carcinoma of the prostate. Three courses of adjuvant chemotherapy (M-VAC) were performed, and tumor recurrence was not recognized 9 months after the operation. This is the 35th case of primary transitional cell carcinoma of the prostate in the Japanese literature.