Atypical Cutaneous Metastasis of Urothelial
Bladder Carcinoma: A Case Report
Aynaou Mohammed*, Mhanna Tarik, El-houmaidi Amine, Paapa Dua-Boateng and Barki Ali
Department of urology, university Hospital Mohammed VI Oujda, Morroco
Submission: July 26, 2019; Published: Septembre 09, 2019
*Corresponding author:Aynaou Mohammed, Department of urology, university Hospital Mohammed VI Oujda, Morroco
How to cite this article:Aynaou Mohammed, Mhanna Tarik, El-houmaidi Amine, Paapa Dua-Boateng, Barki Ali. Atypical Cutaneous Metastasis of
Urothelial Bladder Carcinoma: A Case Report. JOJ uro & nephron. 2019; 6(5): 555700. DOI: 10.19080/JOJUN.2019.06.555700
Introduction: Cutaneous metastasis is an atypical localization of urothelial bladder carcinoma, with poor prognosis
Case: A 60-year-old patient was diagnosed with urotherial carcinoma infiltrating the chorion pT1 low grade. This patient was lost sight of before presenting himself 3 years later with diffuse cutaneous lesions. Histological examination revealed cutaneous metastases from bladder urothelial carcinoma. The patient was subsequently addressed to the oncology department for palliative chemotherapy
Conclusion: Cutaneous metastasis is a rare dissemination of bladder tumor making it difficult to manage.
Cutaneous metastasis is a rare and serious tumor site bladder, their incidence is of the order of 0.22% . These cutaneous metastases are often in the form of infiltrating plaques or nodules , and it appears late after the primary location we report through this observation one of the rare cases described in the literature concerning the occurrence of cutaneous metastases secondary to urothelial carcinoma of the bladder.
This is a 60-year-old, 30-pack-year chronic smoking patient who was initially admitted to our structure for clammatic
hematuria. The latter had been evolving for 3 months without being able to consult. The patient benefited from biopsy transurethral resection whose anatomopathological study has found to be urothelial carcinoma infiltrating the chorion classified pT1 low grade.
This patient was lost sight of before presenting himself 3 years later to urology consultation after the alteration of its general condition (Figures 1 & 2). An extension assessment consisting of a thoraco-abdominopelvic scan was performed and objectified diffuse lymph node metastasis. The patient was subsequently addressed to the oncology department for additional support and benefit from palliative chemotherapy.
The first case of cutaneous metastases secondary to a
bladder tumor was reported in the literature in 1909 . The
cases noted are extremely rare . They are directly related to
the degree of infiltration of the tumor, its size and grade [4,5].
However, metastasis can also appear in superficial tumors
. The most common metastatic sites of urogenital origin
are regional lymph nodes, liver, lung, and bone. Metastatic
dissemination can be by hematogenous, lymphatic, contiguous,
or iatrogenic manipulation at the origin of the implantation of
tumor cells. This latter mechanism is most frequently responsible
for cutaneous metastases [7-9]. According to the data of the
literature, cutaneous metastasis appears after an average delay
of 18 months . A single case of cutaneous metastases that
occurred several years (10 years) after the diagnosis of the
primary tumor was reported
The clinical aspect of metastasis can take many forms.
Brownstein et al described 3 main clinical aspects: the lesion
nodular, scleral lesion and inflammatory lesion . Their
favorite seats are the face, the neck, the trunk or the extremities
[7,10]. The biopsy, a simple gesture, makes it possible to
establish the diagnosis, but the urothelial origin remains
sometimes difficult to affirm . It shows nests of malignant
cells with eosinophilic cytoplasm. Most of these cells express
cytokeratin 7 and 20 in the immunohistochemical study. Studies
have shown that uroplakin III can be detected in 50 to 60% of
primary urothelial carcinomas and metastatic carcinomas of
urothelial origin [10,13].
The prognosis is pejorative with a life expectancy of less
than one year . The treatment of cutaneous metastasis is
like that of other metastatic forms of malignant tumors of the
bladder. Palliative chemotherapy remains the only therapeutic
option for patients who can tolerate it. Combinations based on
cisplatin , including the cisplatin / gemcitabine protocol or the
methotrexate / vinblastine / doxorubicin / cisplatin protocol,
are the treatment standards for unresectable or metastatic
locally advanced bladder tumors . Surgery is indicated in
front of small lesions localized while the use of radiotherapy for
palliative care has not yet been studied .
The diagnosis of cutaneous metastases must always be
evoked in front of cutaneous lesions in the patients having a
history of cancer. Palliative care is the only valid therapeutic
option, and the prognosis is unfavorable.