Cutaneous metastases from transitional cell carcinoma of the bladder

Cutaneous metastases: From epidemiology to therapy

Cutaneous metastases are seen in up to 10% of all oncology patients and can occur in different locations depending on the entity. Cutaneous metastases are often associated with a high psychological burden and, especially in the case of exulceration, with shame and social withdrawal. This review discusses the diagnostic and therapeutic options. The most common tumor entities in which cutaneous metastases are observed are discussed, and local and systemic treatment options are presented according to the current state of research.

Unusual metastasis after radical cystectomy: case report

Cutaneous metastasis of urothelial carcinoma after radical cystectomy is extremely rare. We present the case of a 57-year-old man who underwent a radical cystectomy with ileal conduit for the presence of a bladder tumor. He developed a cheek lesion after 2 months, which was diagnosed as a metastatic nodule along with bone metastases from high-grade bladder urothelial carcinoma. This nodule was treated with surgical removal with subsequent chemotherapy, but he succumbed after 10 months due to widespread metastatic disease.

Cutaneous metastasis of bladder urothelial carcinoma; A rare conditions

Cutaneous is an extremely rare metastatic area of bladder urothelial carcinoma. Pure cutaneous metastasis without systemic metastasis is very rare and less than ten cases have been reported in the literature. Our patient had various lymphatic fistulas to her skin due to pelvic lymphadenectomy and radiotherapy in her previous cervical cancer. We believe that the most probable mechanism underlying our patient's cutaneous metastasis is a lymphatic spread via those lymphatic fistulas. Immunotherapy is a very important option for patients who cannot receive cisplatin. This is the second case in the literature to apply immunotherapy in the setting of cutaneous metastasis of bladder cancer.

Cutaneous metastasis emerging during chemotherapy and progressing during immunotherapy for urothelial carcinoma

INTRODUCTION

Cutaneous metastasis of urothelial carcinoma is uncommon. We experienced a case of cutaneous metastasis that emerged during chemotherapy and progressed rapidly during immunotherapy for bladder tumor with lymph node metastasis.

CASE PRESENTATION

A 77-year-old female patient received chemotherapy using gemcitabine and cisplatin for bladder urothelial carcinoma with para-aortic and pelvic lymph node metastases (clinical stage T2N1M1). After eight courses of chemotherapy, skin rash appeared in the lower abdomen with leg edema caused by multiple lymphadenopathy. Skin biopsy revealed cutaneous metastasis of urothelial carcinoma. The cutaneous tumor progressed rapidly and the patient died 5 weeks after the start of second-line pembrolizumab treatment.

CONCLUSION

A patient with cutaneous metastasis of urothelial carcinoma that emerged during chemotherapy had poor prognosis and lack of efficacy of an immune checkpoint inhibitor.

Urothelial carcinoma of the bladder with cutaneous metastases after robot-assisted radical cystectomy. Case report

Bladder cancer is one of the common urologic malignant diseases.

Cutaneous metastasis of bladder cancer is rare, with only a few case reports. The pattern of metastasis from bladder cancer is not well described.

We report a patient with muscle-invasive bladder cancer who developed skin metastases after neoadjuvant chemotherapy and robot-assisted laparoscopic radical cystoprostatectomy. Skin metastases were confirmed histopathologically by skin biopsy.

This case reminds us of the need to consider the possibility of skin metastasis in the differential diagnosis of skin symptoms in patients with malignant diseases.

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We reported a patient developed skin metastases after neoadjuvant chemotherapy and robot-assisted laparoscopic radical cystoprostatectomy.

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This is the first documented case of skin metastases of bladder cancer after robot-assisted radical cystectomy.

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This case reminds the necessity of taking into account skin metastasis in patients with malignant diseases.

Cutaneous metastasis of bladder urothelial carcinoma

Cutaneous metastases of genitourinary malignancies are an extremely rare phenomenon. Few cases of skin metastasis from urothelial carcinoma of the bladder have been reported. We report a case of 71-year-old female with primary bladder transitional cell carcinoma who presented with the initial presentation of cutaneous skin lesions that covered the entire lower abdominal wall.

Unexpected skin lesions secondary to metastasis of urothelial carcinoma

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Skin metastases of urothelial bladder carcinoma are rare.

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The inflammatory presentation, as seen in our case, is exceptional.

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Diagnosis requires immunohistochemical study of a skin biopsy.

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The prognosis after the appearance of cutaneous metastasis is poor.

Introduction

Metastatic spread of urothelial bladder carcinoma (UBC) rarely involves the skin which is associated with a poor prognosis. We present a rare case of UBC with cutaneous metastases which is exceptional by its inflammatory clinical form.

Presentation of case

A 62-year-old male was diagnosed with a non-metastatic muscle invasive transitional cell bladder carcinoma invading the anterior wall of the rectum. Cisplatin-based chemotherapy was indicated but refused by the patient. Three months later, he developed cutaneous lesions in the left axilla and the right inguinal fold. These lesions were budding, nodular and inflammatory corresponding to carcinomatous metastasis on skin biopsy which urothelial origin was confirmed by immunohistochemical analysis. The patient died four weeks later after multi-organ failure.

Discussion

Skin metastasis of transitional cell carcinoma of the bladder are uncommon, representing 0.84% of all cutaneous metastases. The inflammatory presentation, as seen in our case, is rarer than the other types and is usually due to a lymphatic extension. The clinical appearance of cutaneous metastases might mimic other common dermatologic disorders; Thus, diagnosis requires histological confirmation by microscopic examination and immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastases is generally poor with a median disease-specific survival of less than 12 months Treatment is palliative and is principally based on chemotherapy, analgesics and psychological support.

Conclusion

Cutaneous metastases secondary to urothelial bladder carcinoma are exceptional especially in its inflammatory presentation. Diagnosis is based on immunohistochemical study. Treatment is based on chemotherapy and the prognosis is poor.

Metastatic adenocarcinoma of bladder presenting with skin and visceral metastasis

A 62-year-old male patient presented with multiple subcutaneous swellings over neck, axilla and scapular region for last 3 months. Further evaluation revealed the presence of bladder mass, deranged kidney function tests with multiple rounded opacities in lung. The patient was stabilised with haemodialysis and bilateral percutaneous nephrostomy tube placement. The patient was planned for multiagent chemotherapy after stabilisation but died within 2 weeks due to progressive disease. Fine needle aspiration cytology (FNAC) from the above-mentioned skin and lymph nodes swellings was suggestive of adenocarcinoma. We herein report this rare case of a metastatic adenocarcinoma of the bladder with extensive skin and visceral metastasis. The presence of skin metastasis confers a poor prognostic sign to the patient. They are usually resistant to available treatment modalities. To our knowledge, this is the first reported case of adenocarcinoma metastatic to skin and viscera.

Transitional Bladder Cell Carcinoma Spreading to the Skin

Cutaneous metastases from bladder malignancies are rare. We report the case of a 74 year old man who underwent cysto-prostatectomy and adjuvant chemotherapy for a pT3b N+ bladder transitional cell carcinoma. Four months later, he presented with skin disseminated pigmented lesions. Skin biopsy confirmed cutaneous metastasis from urothelial carcinoma.

Cutaneous metastasis: An unusual presenting feature of urologic malignancies

Urological malignancies are well known for their ability to metastasize widely. The incidence of cutaneous metastasis from all urologic malignancies has been reported to be 0.73–1.3% with the primary most commonly being renal cell carcinoma followed by carcinoma bladder, adenocarcinoma prostate, and testicular germ cell tumor in decreasing order of frequency. Metastasis to the skin is unusual and has been predominantly reported as a late manifestation of the disease. We describe two patients with urologic malignancies who had cutaneous metastasis as their initial presenting feature.

Cutaneous invasion from sarcomatoid urothelial carcinoma: clinical and dermatopathologic features

In Brazil, without considering the non-melanoma skin tumors, bladder cancer in men is the eighth most common, and the urothelial carcinoma or transitional cell carcinoma is the most common among these. Cutaneous metastases from urothelial neoplasms appear as single or multiple erythematous, infiltrated nodules or plaques, and like other cases of distant disease, it is indicative of poor prognosis. The invasive urothelial carcinoma is recognized for its ability to present divergent differentiation and morphological variants. The sarcomatoid urothelial carcinoma is a rare cancer that consists of two different components: one composed of epithelial tissue and the other with sarcomatoid features of mesenchymal origin. The authors describe a case of cutaneous metastasis of sarcomatoid urothelial carcinoma in a 63-year-old male patient.

Cutaneous metastasis of transitional cell carcinoma of the urinary bladder eight years after the primary: a case report

INTRODUCTION

Cutaneous metastasis of bladder carcinoma is extremely rare with a limited number of published cases. An awareness of this rare clinical entity and high index of suspicion is needed for diagnosis, as it can occur months or rarely as in this case, even years, after the primary cancer.

CASE PRESENTATION

An 81-year-old Caucasian man presented with a one-year history of increasing left leg swelling and a two-month history of a macular-nodular rash on the anterior thigh, on a background of a high-grade (WHO Grade 2 of 3) papillary and invasive transitional cell carcinoma of the bladder in 2006. Following investigations, he was diagnosed as having probable locoregional recurrence of previously resected urothelial cancer of the bladder with extensive retrograde lymphatic permeation into the left thigh with cutaneous eruptions of malignancy. He completed a planned course of palliative radiation therapy to the left thigh lesions (30 Gy divided over 10 fractions) as well as the left pelvic node (a total dose of 18 Gy divided over six fractions). The disease ran an aggressive course and our patient died six months after the diagnosis of cutaneous metastases.

CONCLUSIONS

Metastatic disease should always be considered in the differential diagnosis in patients with a previous history of bladder cancer who present with cutaneous nodules, even many years after the initial diagnosis at the primary site.

Choroidal and cutaneous metastasis from urothelial carcinoma of the bladder after radical cystectomy: a case report and literature review

Bladder cancer is the second most common genitourinary malignancy and has variable metastatic potential; however, choroidal and cutaneous metastases are extremely rare. Generally, a patient with these uncommon metastases has a very poor prognosis. We present a bladder cancer patient with a visual disorder in the right eye and multiple nodules on head and lower abdomen that developed 17 months after a radical cystectomy. These symptoms were determined to be caused by choroidal and cutaneous metastasis of bladder cancer. Although two cycles of combination chemotherapy were performed, the patient died 5 months after diagnosis of multiple metastases.

[Atypical scalp and adrenal metastasis of a urothelial carcinoma of the bladder]

Les métastases du cuir chevelu et surrénaliennes d'un carcinome urothélial de la vessie sont rares, peu de cas ont été rapportés dans la littérature, et la chimiothérapie est le traitement de choix. Nous rapportons le cas d'une femme de 60 ans qui présente un carcinome urothélial stade IV avec métastases surrénaliennes, pulmonaire et osseuses (cotes et scapula). Deux lignes de chimiothérapies ont été instaurées et la patiente bénéficia d'une radiothérapie palliative antalgique sur la scapula. Après la première ligne de chimiothérapie, une masse du cuir chevelu augmentant progressivement de volume apparue, une biopsie fut faite et le diagnostic de métastase d'un carcinome urothélial de la vessie fut confirmé par l'histologie.

Cutaneous metastasis of transitional cell carcinoma of the urinary bladder: Cytological aspect

Cutaneous metastasis from transitional cell carcinoma urinary bladder is a rare clinical entity associated with poor prognosis. This case report describes a 51-year-old male who presented with multiple cutaneous metastases arising from high grade transitional cell carcinoma bladder with lamina propria invasion. The prominent cytological features include medium sized to large pleomorphic cells with irregular nuclear outlines, coarse chromatin pattern, and tumor giant cells. An awareness of this rare clinical entity and high index of suspicion is needed for diagnosis.

Unusual presentation of cutaneous metastasis from bladder urothelial carcinoma

Cutaneous metastases from urothelial carcinoma of the bladder are a rare disease. In previous reports, the most common metastatic cutaneous lesions were non-tender nodules on the abdominal skin. We report a patient with bladder urothelial carcinoma with cutaneous metastases initially presenting as right leg and suprapubic lymphedema. Bladder tumor was the incidental finding by magnetic resonance venography. Urothelial carcinoma (clinical stage IV) was diagnosed, and chemotherapy was performed. Extensive painful erythematous plaques with an erysipelas-like appearance located on the suprapubic area, chest and abdomen were noted, and cutaneous metastases were confirmed by histopathology. Subsequently, extensive scrotal and prepuce ulcerative changes developed. This paper reports a rare case of extensive cutaneous metastasis of bladder urothelial carcinoma who presented an interesting clinical course.

Solitary skin metastasis from sarcomatoid carcinoma of the bladder: a case report

INTRODUCTION

Cutaneous metastases from carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. The common treatment modality of cutaneous metastases from a primary bladder cancer is wide local excision followed by chemotherapy.

CASE PRESENTATION

We report a case of solitary skin metastasis from a rare type of urinary bladder carcinoma in a 68 year-old Caucasian man. Urinary bladder carcinoma metastasizing to the skin is an uncommon finding despite the high incidence of this tumor. Skin metastasis generally presents in the late stages of this disease and indicates a poor outcome.

CONCLUSIONS

Because of the extremely aggressive malignant potential of sarcomatoid carcinomas, the indications for a transurethral resection of the bladder should be carefully assessed and suitable therapeutic strategies should be examined further.

Metastatic bladder transitional cell carcinoma presenting as a vascularised cutaneous right arm lesion

A 65-year-old man presented to the emergency department with a 3-week history of a fast-growing and painful mass in his right antecubital fossa. He felt otherwise well. Four months earlier, he had undergone a radical cystectomy for transitional-cell carcinoma (TCC) of the bladder (grade 3, stage pT1). Two months after the cystectomy, at another hospital, he was diagnosed with, and treated for, a pseudoaneurysm in his right antecubital fossa. Duplex ultrasonography of the presenting lesion revealed a highly vascularised mass with no pseudoaneurysm. Histological and immunohistochemical analysis preceded a diagnosis of cutaneous metastatic TCC. Whole-body CT revealed widespread metastases. This is the first reported case of a highly vascularised cutaneous lesion being the presenting feature of metastatic bladder TCC.

Mixed germ cell tumor metastatic to the skin: case report and literature review

Background

Testicular cancer is the most common cancer for males aged 15~35 years old. The initial presentation is typically an asymptomatic enlarged testicle. The retroperitoneum is the most common metastatic area. Other metastatic sites include the lung, liver, brain, adrenal glands, gastrointestinal tract and spleen. Skin metastasis is a rare event and frequently associated with poor prognosis.

Case presentation

A 19-year old male was diagnosed testicular mixed germ cell tumor with initial presentation of cutaneous metastasis at scalp and upper abdomen. After radical orchiectomy and four courses of cisplatin-based chemotherapy, the scalp and upper abdominal lesions regressed completely. The size of lung metastases remained unchanged.

Conclusions

For advanced stage testicular cancer, cisplatin-based chemotherapy is still effective to achieve partial response.

Presentation and management of a patient with subcutaneous metastatic transitional cell carcinoma of the bladder

BACKGROUND

A 60-year-old female with a 6-month history of muscle-invasive transitional cell carcinoma of the bladder presented with an enlarging subcutaneous lesion involving her right flank. She had previously undergone radical cystectomy, bilateral pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction.

INVESTIGATIONS

Axial fused fluorodeoxyglucose PET-CT of the chest, abdomen and pelvis, fine needle aspiration with direct ultrasound guidance, excisional biopsy and immunohistochemistry.

DIAGNOSIS

Subcutaneous and liver metastases of transitional cell carcinoma.

MANAGEMENT

Wide local excision of the subcutaneous lesion followed by combination gemcitabine-cisplatin chemotherapy. Gemcitabine was administered at a dose of 1,000 mg/m(2) on days 1, 8, and 15, and cisplatin was administered at a dose of 75 mg/m(2) on day 1; the schedule was repeated every 28 days for three cycles.

Management kutaner Metastasen

Cutaneous metastases are rare and usually signify a poor prognosis. The manifestation of cutaneous metastases is variable; crucial to their diagnosis is their inclusion in the differential diagnosis. The therapy occurs mostly with palliative intention. The quality of life of the patient should take first priority. A combination chemotherapy is usually carried out because of systemic progress. For local tumor control and wound care, metastasis surgery and radiotherapy are used.