Metastatic non-muscle-invasive bladder cancer – A case report
Juhász Dániel dr.1, Szendrői Miklós dr.2, Nyirády Péter dr.1, Riesz Péter dr.1
1Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
2Semmelweis Egyetem, Ortopédiai Klinika, Budapest (igazgató: Szőke György dr.)
Introduction: Malignant neoplasm of the urinary bladder is the second most common malignancy in urological patients. Non-muscle-invasive bladder cancer causes distant metastasis in less than 10% of cases. In the literature available, very few metastases to non-muscle-invasive bladder cancer has been described in a variety of locations.
Case report: A 61-year-old female patient treated with type 2 diabetes mellitus visited our clinic in 2017. She had a history of 2008 with transurethral bladder tumour resection (TURTU). Histological examination resulted in pT1GrII low grade urothelial cell carcinoma. In 2013, X-ray and SPECT were performed due to lower left limb pain, which confirmed osteolytic lesion in the diaphysis of the left femur. The patient underwent left proximal femoral resection and tumor endoprosthesis implantation at the Department of Orthopaedics, Semmelweis University. Histological examination of the removed specimen confirmed the metastasis of urothelial cell carcinoma. Staging CT scan and cystoscopy did not confirm metastasis or relapse in the bladder. The patient did not submit to a control examination from 2014 for 3 years. In 2017, CT scan and cystoscopy confirmed recurrent bladder cancer. Transurethral resection of the bladder happened. Histologic examination confirmed T1GrII low grade transitional cell carcinoma. The patient underwent cystoscopy every 3 months and since then no recurrence was detected.
Discussion and conclusion: Non-muscle invasive bladder tumours cause metastases less than 10% of the cases. They can be recognised in variety of the locations. Type 2 diabetes mellitus is a predisposing factor for metastasis formation in patients treated by non-muscle invasive bladder cancer. National and international guidelines do not recommend additional staging imaging (eg. bone scintigraphy, x-rays) for low grade non-muscle invasive bladder carcinoma. In the present case, attention should be drawn to the possibility of metastasis when symptoms and abnormal imaging are observed.