Unusual Presentation of Cutaneous Metastasis from Bladder Tumour: Two Case Reports of Rare Implantation

Case Presentation

Ann Surg Perioper Care.2016; 1(3): 1016.

Unusual Presentation of Cutaneous Metastasis from Bladder Tumour: Two Case Reports of Rare Implantation

Pastore AL¹*, Palleschi G¹, Fuschi A¹, Velotti G¹, Leto A¹, Yazan A¹ Salhi Y¹, Porta N², Petrozza V² and Carbone A¹

¹Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy

²Pathology Unit, ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy

*Corresponding author: Antonio Luigi Pastore, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy

Received: November 17, 2016; Accepted: December 21, 2016; Published: December 23, 2016

Abstract

Cutaneous metastasis from the transitional cell carcinoma (TCC) of the bladder is extremely rare. This paper describes two uncommon cases of patients presented with a single fast-growing skin lesion accompanied by pain. The first case involved a 55-year-old male patient with a lesion in the anterior abdominal wall who underwent radical cystectomy five months earlier. The second case involved a 70-year-old female patient with a single, nodular bleeding skin lesion raised in the left submammary region that underwent radical mastectomy two years earlier. CT-scan showed a 3cm nodular solid, subcutaneous lesion with contrast enhancement involving the left rectus abdominis muscle in the male patient and a 2cm nodular solid lesion to the left hypochondria suspicious for metastatic disease in the female patient. The histopathologic examination subsequently confirmed TCC metastasis in both the cases. This report highlights the importance of a high-index of suspicion of skin urothelial metastases to avoid misdiagnosis and also supports the use of immunohistochemical staining for the determination of the primary origin of the tumour.

Keywords: Cutaneous metastasis; Urothelial cancer; Skin lesion; Bladder cancer; Immunohistochemical staining

Introduction

Cutaneous metastases from genitourinary cancers are rare entities. Hence, the practising urologist plays an essential role in the management (treatment and follow-up) of patients with malignancies arising from the genitourinary tract.

Consequently, the differential diagnosis of a skin lesion should include cutaneous metastasis to avoid misdiagnosis.

The most common sites of metastatic disease from urologic tumours include the regional lymph nodes, liver, lungs, and bones. Some rare cases may also involve the axial and peripheral skeletal muscle, central nervous system, pancreas, stomach and testes [1].

The current study describes two cases of metastasis of transitional cell carcinoma (TCC) of the bladder: a 55-year-old man with a lesion in the abdominal wall involving the left rectus abdominis muscle, and a 70-year-old woman with a “zosteriform”-like lesion to the left submammary region mimicking herpes zoster or a likely metastasis from the breast tumour. To the best of our knowledge, both are rare cases of early metastatic disease of bladder cancer in the abdominal wall.

Case Presentation

Case 1

On January 2015, a 55-year-old Caucasian male presented to the outpatient clinic with a three-week history of gross haematuria and a month history of a single fast-growing skin lesion accompanied by pain in the abdominal wall. Five months prior to this, in August 2014, the patient had been diagnosed with muscle-invasive bladder cancer for which he underwent intracorporeal laparoscopic radical cystectomy along with orthotopic ileal neobladder [2] for stage pT3b N1 TCC.

The histopathological examination revealed an epithelial malignant proliferation, superficially organised into papillary structures, which is further organised in solid nests and cords that infiltrate the subepithelial corium and the muscularis. The cells showed immunoreactivity for CK AE1/AE3 and CK7 (Figure 1).

Citation: Pastore AL, Palleschi G, Fuschi A, Velotti G, Leto A, Yazan Al Salhi Y, et al. Unusual Presentation of Cutaneous Metastasis from Bladder Tumour: Two Case Reports of Rare Implantation. Ann Surg Perioper Care. 2016; 1(3): 1016. ISSN:2573-5314