Metastatic hepatocellular carcinoma in the urinary bladder with radiation-induced hemorrhagic cystitis

Hepatocellular carcinoma metastasis presenting as a pedunculated bladder mass

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is a sign of advanced disease with poor prognosis. Haematogenous metastasis to the urinary bladder is extremely rare. We describe a case of a 66-year-old male with advanced HCC that developed HCC metastasis to the bladder. There have only been six case reports previously documenting this. Uniquely this is the first case to develop metastatic disease to the bladder after receiving both locoregional and systemic therapy.

A case of urinary bladder metastasis of hepatocellular carcinoma following use of immunotherapy/tyrosine kinase inhibitor

Introduction

Here we present a rare case of hepatocellular carcinoma metastasis to the urinary bladder in a patient with metastatic HCC.

Case presentation

An 83-year-old man developed gross hematuria during combined treatment with an anti-programmed death-ligand 1 inhibitor and an anti-vascular endothelial growth factor for metastatic HCC. A contrast-enhanced CT revealed a 15 × 15 mm soft tissue mass protruding from the posterior bladder wall. Cystoscopy further revealed a solitary submucosal mass located on the posterior wall. The patient underwent transurethral resection of bladder tumor. The pathological findings were consistent with a diagnosis of bladder metastasis from HCC. Following a 3-week interval after the surgical intervention, salvage therapy was resumed.

Conclusion

During follow-up after TUR-BT in HCC patients who present with a bladder tumor, the possibility of HCC metastases to the urinary bladder should be excluded.

Rare case of hepatocellular carcinoma metastasis to urinary bladder: A case report

BACKGROUND

Hepatocellular carcinoma (HCC) is a primary liver cancer with high prevalence and mortality. There are many cases of advanced HCC at the time of diagnosis. Treatment methods and prognosis are different depends on whether metastasis is present. Thus, it is necessary to make an accurate evaluation at the time of diagnosis. Extrahepatic metastases of HCC usually occur through hematogenous spread or through adjacent organs such as the peritoneum. Metastasis to the urinary bladder alone is rare. Here, we report a rare case of biopsy-proven solitary metastasis of HCC to the bladder in a 60-year-old woman.

CASE SUMMARY

A 60-year-old female patient was found to be positive for hepatitis B surface antigen by chance after abdominal ultrasonography showed abnormal findings. Thus, liver dynamic computed tomography (CT) was performed. The patient visited the hospital for further examination. Ultrasound and CT showed 3.6 cm sized arterial enhancing mass in segment 5 and an infiltrative mass in segment 8. The patient was diagnosed with HCC through liver dynamic magnetic resonance imaging and liver biopsy. Afterwards, she underwent two transcatheter arterial chemoembolizations within five months for HCC. During follow-up, a newly appeared bladder tumor was found on liver dynamic CT. She underwent transurethral resection of the bladder tumor for diagnosis and treatment. The tissue was confirmed as metastatic HCC.

CONCLUSION

Although rare, metastasis to urinary bladder from HCC can occur without evidence of other distant metastases. Thus, regular follow-up imaging examination and clinical attention are required.