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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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Brenneman RJ, Gay HA, Christodouleas JP, Sargos P, Arora V, Fischer-Valuck B, Huang J, Knoche E, Pachynski R, Picus J, Reimers M, Roth B, Michalski JM, Baumann BC. Review: Brain Metastases in Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nearly 50% of bladder cancer patients either present with metastatic disease or relapse distantly following initial local therapy. Prior to platinum-based chemotherapy, the incidence of bladder cancer central nervous system metastases was approximately 1%; however, their incidence has increased to 3–16% following definitive treatment as platinum-based regimens have changed the natural history of the disease. Bladder cancer brain metastases are generally managed similarly to those from more common malignancies such as non-small cell lung cancer, with surgery +/–adjuvant radiotherapy, or radiotherapy alone using stereotactic radiosurgery or whole brain radiotherapy. Limited data suggest that patients with inoperable urothelial carcinoma brain metastases who are not candidates for stereotactic radiosurgery may benefit from shorter whole brain radiation therapy courses compared to other histologies, but data is hypothesis-generating. Given improvements in the efficacy of systemic therapy and supportive care strategies for metastatic urothelial carcinoma translating in improved survival, the incidence of intracranial failures may increase. Immune checkpoint blockade therapy may benefit cisplatin-ineligible metastatic urothelial carcinoma patients as first-line therapy; however, the effectiveness of immune checkpoint blockade to treat central nervous system disease has not been established. In this review, we discuss the incidence and management of bladder cancer brain metastases and considerations regarding variations in management relative to more commonly encountered non-urothelial histologies.
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Affiliation(s)
- Randall J. Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - John P. Christodouleas
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Vivek Arora
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Knoche
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Russell Pachynski
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joel Picus
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Reimers
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruce Roth
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Diamantopoulos LN, Khaki AR, Sonpavde GP, Venur VA, Yu EY, Wright JL, Grivas P. Central Nervous System Metastasis in Patients With Urothelial Carcinoma: Institutional Experience and a Comprehensive Review of the Literature. Clin Genitourin Cancer 2020; 18:e266-e276. [PMID: 32178979 PMCID: PMC7272305 DOI: 10.1016/j.clgc.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Central nervous system (CNS) metastasis in patients with urothelial carcinoma (UC) is uncommon and poorly understood. We aimed to explore the clinical behavior and outcomes of this unique patient population. MATERIALS AND METHODS We performed a retrospective analysis of patients with UC and CNS metastasis, treated in our institution (2006-2018), along with an exploratory patient-point meta-analysis of a similar patient population derived from a comprehensive literature review. Data regarding diagnosis, management, and outcomes were extracted. Overall survival, time to CNS metastasis (TTCM), and residual survival (RS) from CNS involvement to death were calculated (Kaplan-Meier method). Cox regression was used for testing key clinicopathologic associations. RESULTS We identified 20 "institutional" and 154 "literature" patients with adequate data granularity for analysis. Median TTCM was 17.7 (institutional cohort) and 10 (literature cohort) months. Most patients who developed CNS metastases had previous non-CNS metastasis (15/20 [75%] and 103/154 [67%], respectively). CNS lesions without previous history of metastasis were identified in 5/20 (25%) and 33/154 (21%) cases and those patients had a shorter TTCM. CNS lesions in the absence of known UC history were also documented in 18/154 (12%) literature cases. Multifocal CNS disease was associated with shorter RS in both cohorts in univariate, but not multivariate, analysis. CONCLUSION We observed a variability in disease presentation and course, with a subset of patients showing an early predilection for CNS insult, potentially reflecting a diverse underlying biology. Genomic profiling studies, elucidating the molecular landscape, and driving future treatments should be considered in this setting.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ali R Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Guru P Sonpavde
- Division of Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Vyshak A Venur
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center, Seattle, WA.
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4
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Vaa B, Kohli M, Price KA, Swetz KM. Solitary cystic cerebellar metastasis in a patient with invasive transitional cell carcinoma of the bladder. BMJ Case Rep 2014; 2014:bcr-2013-200137. [PMID: 24920508 DOI: 10.1136/bcr-2013-200137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Transitional cell carcinoma of the bladder (TCC) represents nearly 90% of genitourinary malignancies and typically presents with locally invasive symptoms. Metastasis to the central nervous system (CNS) is uncommon occurring in <5% of patients. When present, metastatic lesions are typically solid, isolated and located in the cerebrum. We report a case of a patient with a history of TCC who presented with lethargy and ataxia and was found to have a solitary cystic cerebellar lesion consistent with metastatic disease. Unfortunately, the prognosis for patients with TCC and CNS metastases is poor. Treatment options include debulking surgery, whole brain radiation, stereotactic radiosurgery and chemotherapy. Unfortunately, treatment may not appreciably extend survival and care is often supportive in previously reported cases. Though uncommon, TCC can metastasise to the CNS and should be considered in the differential diagnosis of patients, particularly those who were treated with aggressive surgery or combination chemotherapy previously.
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Affiliation(s)
| | - Manish Kohli
- Mayo Clinic, Rochester, Minnesota, USA Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Mayo Clinic, Rochester, Minnesota, USA Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Keith Mark Swetz
- Mayo Clinic, Rochester, Minnesota, USA Department of General Internal Medicine/Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Sarmiento JM, Wi MS, Piao Z, Stiner ES. Solitary cerebral metastasis from transitional cell carcinoma after a 14-year remission of urinary bladder cancer treated with gemcitabine: Case report and literature review. Surg Neurol Int 2012; 3:82. [PMID: 22937482 PMCID: PMC3424676 DOI: 10.4103/2152-7806.99172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/17/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brain metastases are the most common adult brain tumors, frequently arising from primary tumors in the lung, breast, skin, kidneys, and colon. Transitional cell carcinoma (TCC), the most common type of urinary bladder cancer, is a rare cause of brain metastasis with an ominous prognosis. CASE DESCRIPTION A 68-year-old female presented with right-sided paresis and focal motor seizures of her right upper and lower extremities 14 years after being diagnosed and treated for primary TCC of the urinary bladder with gemcitabine-based chemotherapy. MRI imaging revealed a 3.1 × 3.1 × 2.7 cm heterogeneously enhancing mass located along the posterior aspect of the left frontal convexity. The lesion was accessed using a transsulcal approach and was surgically debulked along the motor cortex with motor strip mapping, followed by adjuvant whole-brain radiation therapy. Pathological examination confirmed metastatic carcinoma with features of TCC, a rare entity among metastatic brain tumors. CONCLUSION Brain metastases may present several years later in patients with TCC of the urinary bladder who have been treated with surgery and chemotherapy. Chemotherapeutic agents that penetrate the blood-brain barrier, such as gemcitabine, may delay development of cerebral metastasis from primary TCC of the urinary bladder.
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Affiliation(s)
| | - Matt S. Wi
- Department of Biochemistry and Molecular Biology, University of California, Riverside, USA
| | - Zhe Piao
- Department of Pathology, Kaiser Fontana Medical Center, Fontana, CA, USA
| | - Eric S. Stiner
- Department of Neurosurgery, Kaiser Fontana Medical Center, Fontana, CA, USA
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D'Souza N, Khan MJ, Robinson S, Motiwala H. A rare and unusual case of isolated cerebellar metastasis from a non-muscle invasive transitional cell carcinoma of bladder. JRSM SHORT REPORTS 2011; 2:50. [PMID: 21731820 PMCID: PMC3127493 DOI: 10.1258/shorts.2011.011014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nigel D'Souza
- Urology Department, Wexham Park Hospital , Slough , UK
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8
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Fokas E, Henzel M, Engenhart-Cabillic R. A comparison of radiotherapy with radiotherapy plus surgery for brain metastases from urinary bladder cancer: analysis of 62 patients. Strahlenther Onkol 2010; 186:565-71. [PMID: 21107928 DOI: 10.1007/s00066-010-2159-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 04/21/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the role of radiotherapy (RT) and prognostic factors in 62 patients with brain metastases from transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS 62 patients received either RT (n = 49), including whole-brain radiotherapy (WBRT) and/or stereotactic radiosurgery (SRS), or surgery (OP) combined with WBRT (n = 13). Overall survival (OS), intracerebral control (ICC) and local control (LC) were retrospectively analyzed. Six potential prognostic factors were assessed: age, gender, number of brain metastases, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from tumor diagnosis to RT. RESULTS Median OS and ICC for the entire cohort were 9 and 7 months. No significant difference between RT and OP + RT was found for OS (p = 0.696) and ICC (p = 0.996). On multivariate analysis, improved OS was associated with lack of extracerebral metastases (p < 0.001) and RPA class (p < 0.001), and ICC with the latter (p < 0.001). SRS-incorporating RT resulted in 1-, 2-, and 3-year LC probability of 78%, 66%, and 51%. No association between LC and any of the potential prognostic factors was observed. The results of the subgroup RPA class analyses were similar to the entire cohort. CONCLUSION Patient outcome for the RT-alone arm was not significantly different from OP + RT. SRS-incorporating treatment offers excellent LC rates. RPA class and the presence of extracerebral metastases demonstrated a significant prognostic role for survival. The latter should be used as stratification factors in randomized trials and can help define the cohort of patients that may benefit from more aggressive therapies.
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Affiliation(s)
- Emmanouil Fokas
- Department of Radiotherapy and Radiation Oncology, Philipps University Marburg, Marburg, Germany.
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10
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Kobayashi T, Ogura K, Nishizawa K, Ono M, Ueno Y, Miyake H, Ide Y. Clinically isolated cerebellar metastasis of renal pelvic urothelial cancer. Int J Urol 2004; 11:47-9. [PMID: 14678185 DOI: 10.1111/j.1442-2042.2004.00735.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 70-year-old man who had undergone radical surgery for renal pelvic transitional cell carcinoma 9 months previously developed solitary cerebellar metastasis. Despite neurosurgical removal, the patient died and post-mortem pathological examination revealed microscopic metastatic lesions within microvessels of the lung. No other lesion, including local residual cancer, was detected.
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Affiliation(s)
- Takashi Kobayashi
- Departments of Urology, Neurosurgery and Surgical Pathology, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
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11
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12
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MAHMOUD-AHMED ASHRAFS, SUH JOHNH, KUPELIAN PATRICKA, KLEIN ERICA, PEEREBOOM DAVIDM, DREICER ROBERT, BARNETT GENEH. Brain Metastases from Bladder Carcinoma: Presentation, Treatment and Survival. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64996-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- ASHRAF S. MAHMOUD-AHMED
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - JOHN H. SUH
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - PATRICK A. KUPELIAN
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - ERIC A. KLEIN
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - DAVID M. PEEREBOOM
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - ROBERT DREICER
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - GENE H. BARNETT
- From the Departments of Radiation Oncology, Urology, Hematology and Medical Oncology and Neurosurgery, Brain Tumor Institute, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio
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13
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Protzel C, Zimmermann U, Asse E, Kallwellis G, Klebingat KJ. Gemcitabine and radiotherapy in the treatment of brain metastases from transitional cell carcinoma of the bladder: a case report. J Neurooncol 2002; 57:141-5. [PMID: 12125975 DOI: 10.1023/a:1015730825896] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hematogenous metastases occur in over 50% of muscle-invasive transitional cell carcinomas (TCC) of the bladder. Despite treatment (mostly surgery and radiotherapy), patients with brain metastases have an especially poor prognosis (median survival 2-5 months), making palliative treatment an important consideration. We followed a 60-year-old man with multiple brain metastases who was ultimately treated with gemcitabine chemotherapy. He underwent a cystectomy in 1997 because of a T3a N0 M0 G3 TCC of the bladder. Two years later, he developed one brain metastasis and one lung metastasis. Both metastases were resected and adjuvant chemotherapy was planned. Before chemotherapy, the patient suffered from headaches and symptoms of hemiparesis. A magnetic resonance imaging (MRI) showed multiple brain metastases of up to 2 cm, particularly in the brain stem. The patient underwent whole-brain radiotherapy with 30 Gy, followed by four cycles of a 3-week gemcitabine (800 mg/m2 on days 1 and 8) schedule. Another MRI showed a nearly complete response after four cycles of chemotherapy, with only small residual tumors remaining in the brain stem. This impressive activity was accomplished without adverse side effects, suggesting that radiotherapy combined with gemcitabine monotherapy may be an excellent choice for palliative treatment of TCC of the bladder.
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Affiliation(s)
- Chris Protzel
- Department of Urology, Medical School of the Ernst-Moritz-Arndt University of Greifswald, Germany.
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14
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Qasho R, Tommaso V, Rocchi G, Simi U, Delfini R. Choroid plexus metastasis from carcinoma of the bladder: case report and review of the literature. J Neurooncol 2000; 45:237-40. [PMID: 10845394 DOI: 10.1023/a:1006346615463] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present here a case report of a 40-year old male with adenocarcinoma of the bladder and solitary metastasis to the choroid plexus of the right lateral ventricle. This is the first such report of such a metastasis in association with bladder carcinoma. Systemic metastases frequently occur in patients with carcinoma of the bladder but involvement of central nervous system is relatively uncommon: less than 1% of patients with carcinoma of the bladder present an intracerebral metastasis. In the majority of cases there are either multiple CNS metastases or other distant metastases. A few cases present with solitary metastases to the CNS without evidence of recurrent or disseminated disease.
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Affiliation(s)
- R Qasho
- Department of Neurological Sciences, Neurosurgery La Sapienza University of Rome, Italy.
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15
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Clatterbuck RE, Sampath P, Olivi A. Transitional cell carcinoma presenting as a solitary brain lesion: a case report and review of the world literature. J Neurooncol 1998; 39:91-4. [PMID: 9760074 DOI: 10.1023/a:1005918508317] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Transitional cell carcinoma of the urinary tract will account for roughly 50,000 new cases of cancer in the US this year. Metastatic involvement to the brain is uncommon with this malignancy. When it does occur, it is usually in the setting of widespread metastatic disease. A rare case of transitional cell carcinoma of the bladder presenting as a solitary brain lesion is reported. In addition, we reviewed the world literature regarding transitional cell carcinoma metastatic to the central nervous system. Our review suggests that metastatic transitional cell carcinoma of the central nervous system has become increasingly common as more effective chemotherapeutic regimens have been developed to control the primary disease. The recent literature also suggests that, much like other metastatic disease to the brain, outcome and survival in patients without widespread disease is improved by aggressive surgical and oncological management.
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Affiliation(s)
- R E Clatterbuck
- Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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16
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Hasbini A, Himberlin C, Beguinot I, Bonnet-Gausserand F, Coninx P. [Carcinomatous meningitis: rare complication of bladder cancer]. Rev Med Interne 1997; 18:402-6. [PMID: 9183449 DOI: 10.1016/s0248-8663(97)82512-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sites of metastases of transitional cell carcinoma of the bladder are nodes, liver, lung and bone, but the meningeal infiltration is rare. Therefore, one case of meningeal carcinomatosis is reported. After cystectomy for an undifferentiated carcinoma of the bladder, the patient received adjuvant chemotherapy. Three months after treatment completion, symptoms of cerebellar ataxia occurred and gradually confusion appeared. The initial cerebra spinal fluid showed clumps of malignant cells. The patient died 15 days after the neurological symptoms occurred. The clinical diagnosis of meningeal carcinomatosis is based on neurological manifestations at more than one level of the neuraxis. Symptoms may present simply as headache or confusion. Meningeal carcinomatosis from urothelial cancer seems to show some specific features: poorly differentiated tumour and high frequency of cerebellar symptoms. Intrathecal treatment essentially has a pain-effect. Mean survival time is as short as 20 weeks. The increasing incidence of this neurological complication in urothelial cancer does not only result from an increase in patient longevity but also from possible side-effects of chemotherapy, so as localized changes in blood-brain barrier permeability induced by antineoplastic drugs. Therefore, we may wonder whether meningeal carcinomatosis might not be regarded as an iatrogenic effect.
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Affiliation(s)
- A Hasbini
- Service de médecine interne-oncologie, institut Jean-Godinot, Reims, France
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17
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Bhalla NK, Khan GM, Padhee A. Case report of pyloric obstruction due to rare cause. Ann Saudi Med 1996; 16:441-3. [PMID: 17372504 DOI: 10.5144/0256-4947.1996.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- N K Bhalla
- Departments of Surgery, King Fahd Hospital and Histopathology, King Khalid Hospital, Tabouk, Saudi Arabia
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18
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Issa MM, Kabalin JN, Dietrick DD, Reese J, Freiha FS. Spermatic cord metastasis from transitional cell carcinoma of the bladder. Urology 1994; 43:561-3. [PMID: 8154085 DOI: 10.1016/0090-4295(94)90258-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of transitional cell carcinoma of the bladder metastasizing to the spermatic cord is reported. This represents the only clinically recognized site of tumor recurrence in a man treated with radical cystoprostatectomy followed by four cycles of adjuvant cis-platinum/methotrexate/vinblastine (CMV) chemotherapy for Stage D1 disease (local pelvic lymph node involvement). The existing literature concerning metastatic tumors of the spermatic cord is reviewed.
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Affiliation(s)
- M M Issa
- Division of Urology, Stanford University Medical Center, California
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19
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Abstract
Response rates of over 50% can be achieved in patients with metastatic transitional cell carcinoma of the bladder treated with cisplatin-based chemotherapy. With prolonged survival, intraparenchymal brain metastases may occur in as many as 12% of patients who received methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy. Meningeal carcinomatosis from urothelial cancer is rare, however. A 71-year-old man, with metastatic, transitional cell carcinoma of the bladder, attained an excellent partial response to M-VAC chemotherapy. He subsequently presented with an acute confusional state 6 months after diagnosis. Head computed tomographic studies were nondiagnostic. Gadolinium-enhanced magnetic resonance images (MRI), however, demonstrated multifocal 1-cm nodules in the brain parenchyma and enhancement of the meninges. Meningeal carcinomatosis was confirmed by lumbar puncture. Records of 40 patients with advanced transitional cell carcinoma of the bladder treated with chemotherapy between 1977 and 1992 at a cancer center were reviewed retrospectively for the occurrence of documented meningeal carcinomatosis, intraparenchymal brain metastases, or both. Among 13 responders, only 1 other patient, a 64-year-old man, was identified who had minimal metastatic disease and attained a complete response to methotrexate and cisplatin. The patient relapsed 2 years after response, with cerebellar metastases and meningeal carcinomatosis. Central nervous system (CNS) metastases in patients with transitional cell carcinoma of the bladder are unusual. Although parenchymal brain metastases may be more common after prolonged remissions induced by combination chemotherapy, meningeal carcinomatosis remains uncommon. MRI may be a useful adjunct in the diagnosis of CNS metastases. A high index of clinical suspicion for the occurrence of CNS metastases from transitional cell carcinoma is encouraged.
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Affiliation(s)
- C Eng
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115
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20
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Salvati M, Cervoni L, Orlando ER, Delfini R. Solitary brain metastases from carcinoma of the bladder. J Neurooncol 1993; 16:217-20. [PMID: 8301346 DOI: 10.1007/bf01057036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report 6 cases of solitary brain metastasis from bladder carcinoma. Although systemic metastases from this cancer are frequent, central nervous system metastases are rare. Analysis of our material and of published cases shows that the tumor is resistant to therapy and the prognosis is consequently very poor.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences, La Sapienza University of Rome, Italy
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Abstract
The records of 28 patients with transitional cell cancer who had brain metastases were retrospectively reviewed. Data from 19 patients were considered suitable for analysis and were included in this study. One patient was treated with surgery alone, 10 with radiation alone and 7 with radiation and surgery, while 1 received no treatment. Mean and median survival times, respectively, were 57 and 42 months from the initial diagnosis, and 11 and 4 months from diagnosis of central nervous system metastases. Patients treated with surgery and radiation demonstrated a mean survival time of 19 months compared to 6 months for patients treated with radiation alone (p = 0.03). There were 2 long-term survivors in the combined modality group at 50 and at 12 months. Enthusiasm for combined modality treatment should be tempered by the fact that selection bias favored the combined modality group; 13 patients with single lesions demonstrated a mean survival of 14 months compared to 3 months for 6 patients with multiple lesions (p = 0.009) and only patients with solitary lesions underwent surgical resection. Brain metastases have an ominous prognosis in patients with bladder cancer primaries. Considering the sum of the retrospective and prospective reports, we recommend that patients with solitary brain lesions and good performance status be aggressively managed with surgical resection and postoperative radiation therapy.
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Affiliation(s)
- M Rosenstein
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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22
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Shamdas GJ, McLaren GD, Grimm T, Everson LK. Solitary cerebellar metastasis from transitional cell carcinoma of bladder. Urology 1992; 40:50-3. [PMID: 1621313 DOI: 10.1016/0090-4295(92)90436-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Brain metastasis from transitional cell carcinoma of the bladder is unusual, occurring most often in the presence of widespread systemic metastases. We report on a patient who presented with an isolated cerebellar metastasis and recurrent carcinoma of the bladder, after treatment with local excision and intravesical thiotepa. Further evaluation failed to demonstrate other distant metastases. Excision of the cerebellar lesion revealed transitional cell carcinoma identical to the original bladder tumor. In a review of the literature, we found reports of two similar patients in whom a solitary cerebellar lesion was the first sign of metastasis from carcinoma of the bladder; neither patient had evidence of other distant metastases, and neither previously had received systemic chemotherapy. These observations indicate that central nervous system metastasis from carcinoma of the bladder, while rare, should be considered in the differential diagnosis of solitary intracerebellar lesions in such patients.
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Affiliation(s)
- G J Shamdas
- Department of Internal Medicine, Fargo Clinic, University of North Dakota School of Medicine
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23
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Angulo JC, López JI, Unda-Urzaiz M, Flores N. Urinary bladder carcinoma initially manifested as brain metastases. Postgrad Med J 1992; 68:150-1. [PMID: 1570262 PMCID: PMC2399226 DOI: 10.1136/pgmj.68.796.150-a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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24
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Kabalin JN, Torti FM, Freiha FS. Transitional cell carcinoma of renal pelvis with multiple cerebral metastases. Urology 1990; 36:531-3. [PMID: 2247923 DOI: 10.1016/0090-4295(90)80195-s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J N Kabalin
- Division of Urology, Stanford GU Oncology Clinic, Stanford University Medical Center, California
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