Cardiac metastasis from a urothelial cell carcinoma: a commented case report

Urothelial bladder cancer with cardiac metastasis: Literature review and case report

INTRODUCTION AND IMPORTANCE

Urothelial bladder cancer can infrequently result in cardiac metastasis, and be usually diagnosed in severe clinical conditions. We report a urothelial bladder cancer with cardiac metastasis and perform a literature review of published cases of transitional cell carcinoma (TCC) of the bladder with cardiac metastasis from 1934 to 2023 published in Pubmed.

CASE PRESENTATION

42-year-old woman with urinnary bladder TCC, underwent radical cystectomy, developing cardiac metastasis after 25 months, cardiac surgery for partial removal of the lesion and using pembrolizumab with the highest reported survival to date.

CLINICAL DISCUSSION

After analysis of 20 case reports in the world among our case, men are more affected, tobacco exposure was the most prevalent risk factor, baseline T3 staging was the most common, and right ventricular and myocardium metastases are more prevalent. The most common symptoms were respiratory failure, changes in cardiac auscultation, and loss of weight. Six patients had cardiac tamponade, and the mean of drained fluid was 1040 ml. Immunohistochemical markers, such as CK7 and Calretinin, were decisive in elucidating the diagnosis. The average time between diagnosis of TCC and cardiac metastasis was 48.69 months, and the survival time after diagnosis of cardiac metastasis was 60.69 days.

CONCLUSION

Bladder TCC with cardiac metastasis is rare and with a low survival rate after the diagnosis. Patients with more advanced stages of TCC deserve diagnostic suspicion of cardiac metastasis if they progress with previously unreported respiratory and cardiac symptoms.

Ultra-rapid regrowth of urothelial cardiac metastasis after debulking surgery

Cardiac metastases of urothelial carcinoma are a rare manifestation, and most of them are asymptomatic or autoptic findings. We report a case of a 64-year-old Caucasian man fully asymptomatic, who has been accidentally diagnosed with a right atrial mass during his routine follow up for previous urothelial cancer. Endomyocardial biopsy, and histological examination of the mass were crucial to reach a definitive diagnosis of urothelial metastasis. He underwent a debulking surgery of the mass to avoid cardiac life-threatening complications. Despite effective removal of the atrial metastasis, after 45 days the patient experienced an ultra-rapid regrowth of the mass in the same position. This case demonstrates how rapidly a urothelial cardiac metastasis can grow back, and that surgery does not avoid by itself early recurrence.

Thoracic Manifestations of Genitourinary Neoplasms and Treatment-related Complications

Genitourinary (GU) malignancies are a diverse group of common and uncommon neoplasms that may be associated with significant mortality. Metastases from GU neoplasms are frequently encountered in the chest, and virtually all thoracic structures can be involved. Although the most common imaging manifestations include hematogenous dissemination manifesting with peripheral predominant bilateral pulmonary nodules and lymphatic metastases manifesting with mediastinal and hilar lymphadenopathy, some GU malignancies exhibit unique features. We review the general patterns, pathways, and thoracic imaging features of renal, adrenal, urothelial, prostatic, and testicular metastatic neoplasms, as well as provide a discussion of treatment-related complications that might manifest in the chest. Detailed reporting of these patterns will allow the imager to assist the referring clinicians and surgeons in accurate determination of the stage, prognosis, and treatment options available for the patient. Awareness of specific treatment-related complications further allows the imager to enhance patient safety through accurate and timely reporting of potentially life-threatening consequences of therapies.