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Önder T, Karaçin C, Kekilli E, Göksel F, Sertesen E, Onur ID, Ateş Ö, Yıldız F, Arslan ÜY. Predicting survival after brain metastases in patients with bladder cancer. J Clin Neurosci 2024; 125:146-151. [PMID: 38815300 DOI: 10.1016/j.jocn.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
AIMS AND OBJECTIVES Because of its rarity, limited data concerning brain metastasis (BM) from bladder cancer (BCa) are available, so this phenomenon remains unclear. We aimed to contribute to understanding this unique patient population's clinical behavior and outcomes. METHODS/MATERIALS This retrospective cohort study included 27 BCa patients with BM treated at our Cancer Institute between April 2009 and December 2022. The time from initial diagnosis to BM and overall survival from BM diagnosis were calculated (Kaplan-Meier method). Cox regression was used to test key clinicopathologic associations. RESULTS A total of 27 patients were included in the study (male/female = 23/4). The median patient age at BM diagnosis was 62.0 (47-79) years. The median interval from initial diagnosis to BM was 11.0 ± 2.59 (95 % CI, 5.91-16.08) months. Twenty (74.0 %) patients were diagnosed with BM by postsymptomatic imaging. The most common symptoms were headache-dizziness (n = 9, 33.3 %), seizure (n = 3, 11.1 %), hemiparesis (n = 2, 7.4 %), and vision defects (n = 2, 7.4 %). The most common sites of extracranial metastasis were the lung (n = 10, 52.6 %), bone (n = 7, 36.8 %), and lymph nodes (n = 6, 31.5 %). More than half of the patients (55.5 %) had multiple BMs. Eight (29.6 %) patients underwent surgery for BM. All of the patients received radiotherapy (RT) for BM (whole-brain radiotherapy (WBRT)/stereotactic radiotherapy (SRT) = 24/3), and eight patients received RT for the second time. Six patients were treated with systemic chemotherapy (CT) after BM. The median survival from BM was 3.0 ± 1.2 (95 % Cl, 0.4-5.5) months in the entire cohort. A low number of BMs (HR 0.270, 95 % CI 0.083-0.885; p = 0.031), surgery for BM (HR 0.174, 95 % CI 0.043-0.712; p = 0.015), CT after BM (HR 0.207, 95 % CI 0.057-0.755; p = 0.017), and better ECOG performance score (HR 0.248, 95 % CI 0.074-0.836; p = 0.025) were associated with better OS. CONCLUSIONS Factors associated with improved survival in BCa patients with BM include a few brain lesions, intracranial resection, CT after BM, and better ECOG performance scores. Larger-scale prospective studies are needed to define the optimal management strategy further.
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Affiliation(s)
- T Önder
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey.
| | - C Karaçin
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - E Kekilli
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - F Göksel
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - E Sertesen
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - I Deliktaş Onur
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - Ö Ateş
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - F Yıldız
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
| | - Ü Y Arslan
- Health Sciences University, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Turkey
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Shipp C, Jindal T, Chou J, Friedlander TW, Koshkin VS, Kumar V. Central Nervous System Disease Progression Among Patients With Metastatic Urothelial Carcinoma Treated With Enfortumab Vedotin: A Case Series. Clin Genitourin Cancer 2024; 22:315-321. [PMID: 38114390 DOI: 10.1016/j.clgc.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Chase Shipp
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Tanya Jindal
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Jonathan Chou
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Terence W Friedlander
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Vadim S Koshkin
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
| | - Vipul Kumar
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
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De Keersmaecker S, Van Cauter S, Bekelaar K. Multiple Ring-Enhancing Brain Lesions: Fulminant Diffuse Cerebral Toxoplasmosis or Cerebral Metastases? Top Magn Reson Imaging 2024; 33:e0311. [PMID: 38598426 DOI: 10.1097/rmr.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
ABSTRACT In this case report, we describe a 76-year-old woman, presenting with dizziness for the past 2 months, without other focal neurological signs. A magnetic resonance imaging of the brain was ordered by her GP. The MRI demonstrated multiple ring-enhancing lesions, both supratentorial and infratentorial. Lumbar puncture showed normal findings, in particular a normal cell count and culture. Because of the radiologic appearance, initially thought to be suggestive of cerebral abscesses, antibiotics were started. However, further workup revealed a new diagnosis of a stage IV (metastatic) small cell lung carcinoma, making diffuse brain metastases more likely. The patient was transferred to oncology/pneumology, where she was started on whole-brain radiotherapy, after which systemic therapy would start. However, because of further clinical deterioration, she was admitted at the palliative ward, where she died only 3 months after the initial presentation. In this case report, we emphasize the importance of keeping a broad differential diagnosis and briefly review the various possible pathologies causing ring-enhancing lesions.
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Tauziède-Espariat A, Masliah-Planchon J, Tran S, Filser M, Saffroy R, Bochaton D, Hasty L, Senova S, Kauv P, Mokhtari K, Adam C, Poté N, Chrétien F, Métais A, Varlet P, Bielle F, Laurenge A. Brain metastasis of a urothelial neuroendocrine carcinoma: A double pitfall for neuropathologists and DNA-methylation profiling. Neuropathol Appl Neurobiol 2024; 50:e12951. [PMID: 38124282 DOI: 10.1111/nan.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Julien Masliah-Planchon
- Institut Curie, Laboratory of Somatic Genetics, PMDT, Paris Sciences Lettres Research University, Paris, France
| | - Suzanne Tran
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
- Department of Neuropathology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Mathilde Filser
- Institut Curie, Laboratory of Somatic Genetics, PMDT, Paris Sciences Lettres Research University, Paris, France
| | - Raphaël Saffroy
- Department of Biochemistry and Oncogenetics, Paul Brousse Hospital, Villejuif, France
| | - Dorian Bochaton
- Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Lauren Hasty
- Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Suhan Senova
- Department of Neurosurgery, Henri Mondor Hospital, Université Paris Est Créteil; Unité INSERM U955 IMRB, Neuropsychiatrie Translationnelle, Créteil, France
| | - Paul Kauv
- Department of Radiology, Henri Mondor Hospital, Créteil, France
| | - Karima Mokhtari
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
- Department of Neuropathology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Clovis Adam
- Department of Pathology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Nicolas Poté
- Department of Pathology, Beaujon Hospital, Clichy, France
| | - Fabrice Chrétien
- Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Alice Métais
- Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Ima-brain Team, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Ima-brain Team, Paris, France
| | - Franck Bielle
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
- Department of Neuropathology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Alice Laurenge
- Department of Neurology 2-Mazarin, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau Et de La Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
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Verheijen EJ, Taal W, Tewari RDN, Giessen MC, Roshani H. Isolated cerebellar metastasis from urothelial carcinoma: A case report of a rare phenomenon. BRAIN & SPINE 2023; 3:102716. [PMID: 38105804 PMCID: PMC10724209 DOI: 10.1016/j.bas.2023.102716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
Introduction Although urothelial carcinoma (UC) generally is non-invasive, contrastingly in 25% of patients UC metastasizes. Isolated central nervous system (CNS) metastasis from UC without other distant metastases are considered rare. In this report we describe a patient with an isolated and solitary cerebellar metastasis from UC. Research question In this case report we explore the value of histological analysis of CNS metastases, imaging, treatment options and survival. Material and methods A rare case is presented of a patient diagnosed with an isolated CNS metastasis originating from UC. Through a systematic review of literature route of dissemination, current imaging and treatment options, and survival are discussed. Results A 77-year-old male was diagnosed with a pT2N0M0 high-grade UC and treated with transurethral resection and chemoradiation therapy. Several months later, the patient presented with neurological symptoms, and radiological imaging revealed a solitary cerebellar mass. A body CT scan showed no other metastasis. After surgical resection, histology confirmed urothelial origin of the mass, matching his primary UC and the patient received post-operative stereotactic radiotherapy at the surgical site. Recurrence of the cerebellar mass occurred after 6 months for which the patient received re-resection. The patient died 5.5 months after re-resection. Discussion and conclusion Isolated brain metastases without other distant metastases from UC are rare, so histologic confirmation of the brain metastasis is essential, particularly when the time interval between diagnosis of the UC and brain metastasis increases. Early brain CT is not recommended. PET CT may have additional value in detection of other distant metastases from UC. Despite advancements in treatments, prognosis for CNS metastasis from UC remains poor.
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Affiliation(s)
| | - Walter Taal
- Neurology, Haga Teaching Hospital, The Hague, the Netherlands
- Department of Neurology/Neuro-Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | - Hossain Roshani
- Departments of Urology, Haga Teaching Hospital, The Hague, the Netherlands
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Kearney M, Zhang L, Hubscher E, Musat M, Harricharan S, Wilke T. Undertreatment in patients with advanced urothelial cancer: systematic literature review and meta-analysis. Future Oncol 2023; 20:1123-1137. [PMID: 37526215 DOI: 10.2217/fon-2023-0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023] Open
Abstract
Aim: To assess rates of no systemic treatment (NST), attrition across lines of therapy, and factors influencing treatment selection in patients with locally advanced or metastatic urothelial cancer (la/mUC). Methods: Systematic literature review to identify real-world studies reporting NST or attrition rates in la/mUC from 2017-2022 (including data reported since 2015). Results: Of 2439 publications screened, 29 reported NST rates, ranging from 40-74% in eight European-based studies, 14-60% in 12 US-based studies, and 9-63% in nine studies in other locations (meta-analysis estimate, 39%). Factors associated with NST or no second-line therapy included older age, female sex, poor performance status, poor renal function and distant metastases. Conclusion: A substantial proportion of patients with la/mUC do not receive guideline-recommended treatment.
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Affiliation(s)
| | | | | | | | | | - Thomas Wilke
- Cytel, Waltham, MA, USA
- IPAM e.V., University of Wismar, Wismar, Germany
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Kono S, Hashimoto Y, Shirai Y, Kunihiro Y, Ohmatsu K, Kawanishi M, Kuribayashi S, Karasawa K. A long-term survival case of bladder cancer with distant metastases: abscopal effect of brain metastases after stereotactic radiotherapy with immune checkpoint blockade therapy to lung metastases. Int Cancer Conf J 2023; 12:205-209. [PMID: 37251008 PMCID: PMC10212856 DOI: 10.1007/s13691-023-00606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
Brain metastases from bladder cancer are rare, with a poor prognosis. There is no standard treatment for bladder cancer with brain metastases; thus, palliative therapy is generally provided. We report a case of abscopal effect in a single brain metastasis from bladder cancer in a patient treated with focal stereotactic radiotherapy (total dose = 52 Gy, administered in eight fractions) with immune checkpoint blockade therapy for lung metastases, who achieved long-term disease-free survival (> 4 years). To our knowledge, although there have been some reports on abscopal effects in bladder cancer, there are no previous reports on patients with brain metastases. To date, the brain metastasis, which showed an "abscopal effect," continues to maintain complete regression.
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Affiliation(s)
- Sawa Kono
- Department of Radiation Oncology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Yaichiro Hashimoto
- Department of Radiation Oncology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Yurie Shirai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Yasuhiro Kunihiro
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Kenta Ohmatsu
- Department of Radiation Oncology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Miki Kawanishi
- Department of Radiation Oncology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Shigehiko Kuribayashi
- Department of Radiation Oncology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
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Guzman SJ, Kleinschmidt-DeMasters BK. Urothelial carcinoma metastases impacting the CNS: A 20-year retrospective series. Ann Diagn Pathol 2023; 64:152109. [PMID: 36822051 DOI: 10.1016/j.anndiagpath.2023.152109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Our group has a longstanding interest in metastases impacting the central nervous system (CNS), including spread from prostatic adenocarcinomas, thyroid carcinomas, and breast carcinomas, most of which metastasize to CNS sites at a later time after the primary tumor is well-known. However, one of the least frequent types of systemic malignancies to metastasize to brain or spine is urothelial carcinoma. Thus, few large studies from a single institution exist. Fewer still detail the interval between first diagnosis of primary tumor and CNS lesion, or whether a patient might have their first presentation of cancer in the brain or spine, thus prompting review of our 20-year experience. MATERIALS Case identification via text word search of pathology databases from our adult and referral hospitals, 2002 to present. Demographic and clinical data were extracted from reports and the medical record. RESULTS 15 cases, 11 male: 4 female, age range 37-82 years were identified. Nine had metastases to brain parenchyma, 5 to vertebral column impacting spinal cord, and 2 to skull, one of which had tumor extension into right parietal lobe. Strikingly, 5 of 15 patients had had their CNS-impacting metastasis as their first presentation of neoplastic disease. CONCLUSIONS CNS metastasis of urothelial carcinoma is a rare occurrence; nevertheless, pathologists should include urothelial carcinoma in their differential diagnosis as a type of cancer that can first present with a CNS-impacting metastasis.
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Affiliation(s)
- Samuel J Guzman
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Zhu LK, Li ZJ, Wang ZB, Chen JT, Zhang HJ, Zhao XW, Liu HY. A rare case of bladder cancer that metastasized to brain, heart, and lung lymph nodes benefited from immunotherapy. World J Surg Oncol 2022; 20:402. [PMID: 36529739 PMCID: PMC9762084 DOI: 10.1186/s12957-022-02876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Bladder cancer is a common malignant tumor of the genitourinary system, with the primary cause of death being metastasis. The most common metastatic sites are the lymph nodes, liver, lung, bone, peritoneum, pleura, kidney, adrenal gland, and the intestine. Brain and heart metastases are rare. In this report, we describe a patient who had pulmonary lymph node metastases more than a year after being diagnosed with bladder cancer, followed by brain and cardiac metastases more than two years later. Following the failure of standard first-line chemotherapy, the patient accepted 6 cycles of tislelizumab immunotherapy. The re-examination revealed that the bilateral frontal brain metastases had vanished, the right temporal lobe metastases had been greatly decreased, the neurological symptoms had been alleviated, and the cardiac metastases had disappeared. This is a rare clinical case with encouraging effects of tislelizumab and can serve as a model for the treatment of similar patients.
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Affiliation(s)
- Lian-kai Zhu
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Zhong-jian Li
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Zhi-bo Wang
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Jin-tao Chen
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Hua-jun Zhang
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Xu-wei Zhao
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
| | - Hong-yao Liu
- grid.470966.aThird Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032 China
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Muacevic A, Adler JR, Hough JM, Mao C, Siddiqi J. Metastatic Urothelial Cell Carcinoma Presenting as an Isolated Malignancy to the Posterior Fossa: A Case Report and Review on the Literature. Cureus 2022; 14:e31909. [PMID: 36579291 PMCID: PMC9792324 DOI: 10.7759/cureus.31909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
Abstract
Urothelial cell carcinoma (UCC) of the bladder infrequently metastasizes to the central nervous system (CNS). The incidence worldwide is approximately 1%. The cerebral hemispheres of the anterior and middle cranial fossa are the most common sites of CNS spread, and usually, multiple metastatic lesions are present. Infrequently, metastasis presents as a single solitary metastatic malignancy to the posterior fossa. Here, we present the case of a patient with bladder UCC who presented with a single solitary metastatic malignancy to the cerebellum. The authors discuss the signs, symptoms, mechanism of metastatic spread to the CNS, diagnosis, management, and prognosis of isolated posterior fossa metastasis originating from bladder UCC. We also performed an extensive literature search to identify all cases of metastatic bladder UCC presenting as an isolated malignancy to the posterior fossa in the past 20 years.
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Sankhyan M, Anderson EM, Urquiaga JF, Hockman JT, Aggarwal R, El Tecle NE, Mercier PJ. Urothelial Carcinoma of the Bladder With Primary Metastasis to the Brain: A Case Report and Literature Review. Cureus 2022; 14:e27587. [PMID: 36059295 PMCID: PMC9433789 DOI: 10.7759/cureus.27587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/05/2022] Open
Abstract
Brain metastases are the most common type of brain tumor in adults, commonly arising from primary tumor sites of the lung, breast, skin (melanoma), colon, and kidney. Isolated central nervous system (CNS) metastasis arising from urothelial carcinoma (UC) is a rare presentation yielding a poor prognosis. A 71-year-old male patient with a history of urothelial carcinoma, treated one year prior with partial cystectomy and adjuvant gemcitabine and cisplatin (GC) therapy, presented with worsening neurological symptoms, including progressively worsening dizziness, shuffling gait, drifting, expressive aphasia, and confusion. MRI revealed a left frontal 4.0 x 3.6 cm brightly contrast-enhancing tumor with possible hemorrhage, extensive vasogenic edema, and moderate mass effect. An additional smaller right cerebellar lesion was also noted. Outpatient CT of his chest, abdomen, and pelvis revealed no evidence of other malignant sites. He ultimately underwent a left craniotomy with a total resection of his left frontal mass. Pathological examination revealed a urothelial primary. Post-operative MRI revealed complete resection of the left frontal mass and the patient was discharged with no neurologic deficits on exam. In many cases, brain metastases may present years later following initial therapy of UC as the CNS may act as a sanctuary site during systemic chemotherapy. Chemotherapeutics such as gemcitabine with better penetration of the blood-brain barrier may be beneficial in delaying the onset of these metastases.
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Metastatic urothelial carcinoma to the brain, spinal cord and spine: A contemporary multi-institutional clinicopathologic analysis of 24 cases. Pathol Res Pract 2021; 224:153537. [PMID: 34243109 DOI: 10.1016/j.prp.2021.153537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Only case reports and small series of metastatic urothelial carcinoma (UCa) to the central nervous system (CNS) or spine have been published. We identified 24 cases at our institutions. The mean patient age was 64 years (range: 41-78 years) with a male predominance. Nineteen (79%) cases involved the brain, 3 (13%) and 2 (8%) cases involved the spinal cord and spine, respectively. Most cases (79%) were a single mass with a mean size of 2.8 cm (range: 0.9-5.5 cm). With the exception of 3 cases demonstrating micropapillary UCa, all metastases showed morphologic features of conventional UCa. Prior to CNS and spinal metastases, there was a history of UCa involving only the bladder in 16 (67%) patients, ureter in 1 (4%) patient, and kidney/renal pelvis in 1 (4%) patient. In 1 additional patient (4%) each, the primary tumor involved both bladder and ureter, bladder and kidney/renal pelvis, and ureter and kidney/renal pelvis, respectively. Three (13%) patients had no known primary site. In two patients, the diagnosis of primary UCa was made concurrently as the CNS metastasis, and ranged up to 30 years in other patients. Follow-up was available in 14 patients with a mean duration of 7 months (range: 0-23 months), and 4 patients died of disease. Both clinicians and pathologists should be aware that concurrent or late CNS or spine metastases may occur and could present as a solitary mass even over a decade after the initial diagnosis.
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Silveira LA, Adams D, DeWitt J, Skidd P, Tranmer B. Urothelial cell carcinoma presenting with rapid visual deterioration, a case of rare brain metastases with unique clinical presentation. Br J Neurosurg 2021; 37:1-4. [PMID: 33629613 DOI: 10.1080/02688697.2021.1887451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Urothelial cell carcinoma (UCC), the most common cancer of the urinary system, rarely metastasizes to the brain. 1-3 More rare still is the subset of patients with urothelial carcinoma brain metastases whose UCC primary is first diagnosed at the same time as their CNS metastatic disease, with oncologic workup prompted by CNS clinical manifestations.4 Paraneoplastic optic neuropathy (PON) is likewise a rare clinical entity, which has not yet been described in association with UCC brain metastases. CASE DESCRIPTION Herein, we present the sentinel case of UCC believed to be of endometrial origin in an 81 year old woman initially presenting with symptoms of fatigue, nausea, vertigo, and rapidly deteriorating vision over the course of 1 month. Visual deterioration prompted neuro imaging remarkable for multiple supratentorial and infratentorial metastases as well as likely neoplastic inflammatory involvement of the bilateral optic nerves. The patient underwent a right temporal open brain biopsy, with pathology findings consistent with UCC. Subsequent PET scanning demonstrated a heavy burden of disease including an FDG-avid uterine mass with local and distal extension of disease including bilateral hydroureteronephrosis with obstruction of the distal ureters. The patient and her family elected to pursue home hospice without further workup or intervention. CONCLUSIONS While this is the first such case presented, it is possible that UCC of the uterine wall represents a particularly aggressive form of the disease more prone to presenting with CNS metastases and PON.
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Affiliation(s)
| | - Dylan Adams
- Neurosurgery, UVM Medical Center, Burlington, VT, USA
| | - John DeWitt
- Neuropathology, UVM Medical Center, Burlington, VT, USA
| | - Philip Skidd
- Neuro-ophthalmology, Neurology, UVM Medical Center, Burlington, VT, USA
| | - Bruce Tranmer
- Neurosurgery, UVM Medical Center, Burlington, VT, USA
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