A rare case of sinchronous bladder metastasis of renal cell carcinoma and a review of the literature

Chiara Mazzariol1, Beatrice Vezzù1, Nicola Piazza1, Fulvio Di Tonno1
  • 1 Ospedale dell'Angelo - U.O. Urologia (Mestre)

Objective

A rare case of synchronous bladder metastasis from of renal cell carcinoma (RCC) and a brief review of the related literature are reported.
The case is reported mainly as a statistic contribution.
Some practical considerations are possible.
The appearance of any type of lesion during the follow-up of patients treated for RCC should be considered as a possible metastases of RCC.
Gross ematuria in patients affected by RCC is caused in most cases by tumor infiltration of the renal pelvis; nevertheless, it should always be investigated, owing to the possible presence of, besides a transitional cell carcinoma, a metastatic involvement of the bladder.

Methods and results

A 80-year-old with hypertension and diabetes was admitted because of haematuria and anemization (Hb= 8.8 g/dL). Physical examination showed hepatomegaly; urinary cytology was negative. Thoracoabdominal CT scan revealed a large (11 cm) solid mass in the right kidney, with renal vein thrombosis and multiple lymph node metastases around the aorta and the iliac arteries, a polypoid lesion in the right lateral wall of the urinary bladder (4cm), liver metastases with porta vein thrombosis, small lung nodules and hilar lymph node metastases. Cystoscopy confirmed the presence of a sessile mass on the right bladder wall, whose appearance was not typical for urothelial neoplasia.
After complete transurethral resection of the bladder tumor, the pathological diagnosis was metastatic RCC of the clear cell type.
The patient was lost at the follow-up.

Discussion

One third of RCC patients has metastatic disease at the initial diagnosis and 30% of all patients will develop distant metastases later on (1).
The most frequent sites of RCC metastases are lung(75%), liver(40%), bone(40%), soft tissue (34%) and pleura(31%) (2); other possible metastatic sites are thyroid, parotid gland, pharynx, eye, pancreas, spleen, skin, intestine, heart and, as in this case, urinary bladder.
The metastatic spread from RCC, either metachronous or synchronous, to the remaining urinary tract, is rare and has been estimated to amount to less than 2% of patients, with less than 40 cases published so far; as regards its pathogenesis, lymphatic, haematogenous and transureteral (“drop metastases”) spread have been hypothesized (3).Prognosis is poor; the three-year survival rate is 80% in the case of a single metastases; survival rates following single metastasectomy are 60% and 38% after, respectively, three and five years (4).
Treatment rely basicly upon endoscopic resection, which can be followed in selected cases by interleukin therapy and/or partial cistectomy; no effective treatment for metastatic RCC is indeed available (1, 5).
The case is reported mainly as a statistic contribution.
The appearance of any type of lesion during the follow-up of patients treated for RCC should be considered as a possible metastases of RCC.
Gross ematuria in patients affected by RCC is caused in most cases by tumor infiltration of the renal pelvis; nevertheless, it should always be investigated, owing to the possible presence of, besides a transitional cell carcinoma, a metastatic involvement of the bladder (2).

References

1)Seung Whan D., Woong B. K., Won J. Y., Jong H. Y., So Young J., Yun Se. Korean J Urol 2013; 54(1):69-72

2)Kruck S., Scharpf M., Stenzl A., Bedke J.. A rare case of synchronous renal cell carcinoma of the bladder presenting with gross hematuria. Rare tumors 2013 April 15; 5(2): 72-74

3)Raviv S, Eggener Se, Williams DH, Garnett JE, Pins MR, Smith ND. Long term Survival after “drop metastes”of renal cell carcinoma to the bladder. Urology 2002 Oct; 60(4): 697

4)Melegari S, Albo G, Rocco B,Verweij F, Abbinante M, De Cobelli O. Metachronous bladder metastes from cell carcinoma: A case report and a review of the literature. Ecancermedicalscience 2010; 4: 175

5)Shiraishi K, Mohri J, Inoue R, Kamiryo Y. Metastastic renal cell carcinoma to the bladder 12 years after radical nephrectomy. Int J Urol 2003 Aug; 10(8): 453-5

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