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LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 1  |  Page : 53-55
 

Adenocarcinoma of urinary bladder in patient with primary gastric cancer: An unusual synchronous distant metastasis


Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication28-Apr-2016

Correspondence Address:
B Lodh
Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.180829

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How to cite this article:
Lodh B, Sinam R S, Singh K A. Adenocarcinoma of urinary bladder in patient with primary gastric cancer: An unusual synchronous distant metastasis. Indian J Cancer 2016;53:53-5

How to cite this URL:
Lodh B, Sinam R S, Singh K A. Adenocarcinoma of urinary bladder in patient with primary gastric cancer: An unusual synchronous distant metastasis. Indian J Cancer [serial online] 2016 [cited 2019 Nov 13];53:53-5. Available from: http://www.indianjcancer.com/text.asp?2016/53/1/53/180829


Sir,

Adenocarcinoma accounts for 0.5-2% of all malignant vesicle tumors and are mostly secondary. [1] The principal primary organs are those that involve by direct extension such as cancers of prostate, cervix, rectum and colon. However, metastasis from a remote primary is considerably rare and in order of frequency includes melanoma, lymphoma, stomach, breast, kidney, lung and liver carcinoma.[2] Here, we present a case of primary gastric carcinoma with its unusual distant metastasis.

A 53-year-old male patient visited the surgery Out Patient Departments, Regional Institute of Medical Sciences with abdominal fullness, nausea, vomiting and intermittent hematuria. There was significant weight loss and history of stool not passed for last 7 days. Physical examination revealed distended, tympanic upper abdomen without any palpable mass. Laboratory investigation showed hemoglobin 6.5 g/dl, carcinoembryonic antigen of 3.1 mg/dl and carbohydrate antigen (19-9) of 48 U/ml. Further investigated with barium meal X-ray showed a filling defect in the gastric antrum [Figure 1]. Upper gastrointestinal (GI) endoscopy revealed a mass on the lesser curvature extending from the body to the antrum [Figure 2] and biopsy showed moderately differentiated tubular adenocarcinoma [Figure 3]. Staging computed tomography (CT) revealed a hypodense lesion on the lesser curvature with extensive invasion into the perigastric structure without any evidence of peritoneal dissemination [Figure 4]. In addition, CT scan revealed a right posterior lateral urinary bladder (UB) mass [Figure 5]. Cystoscopy and biopsy under local anesthesia was carried out that revealed identical histology [Figure 6] and [Figure 7]. Patient underwent palliative gastrojejunostomy along with formal transurethral resection (TUR) of the bladder tumor. At laparotomy, there was no sign of peritoneal wall dissemination. Histopathology of TUR biopsy showed muscular invasion. After 4th week of surgery, he received six cycles of systemic chemotherapy (injection docetaxel 120 mg + injection carboplatin 450 mg) and 60 Gy pelvic irradiation in 30 fraction over a 6 week period. At 3 months follow-up, condition of the patient was found to be satisfactory.
Figure 1: Filling defect (arrow) on barium meal X-ray

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Figure 2: Upper gastrointestinal endoscopy showed growth (arrow) over the lesser curvature extending from the body to the antrum

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Figure 3: Upper gastrointestinal endoscopic biopsy revealed moderately differentiated tubular adenocarcinoma

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Figure 4: Axial computed tomography scan showing growth over the lesser curvature in the region of the body and antrum (black arrow) with loco-regional extension (white arrow)

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Figure 5: Axial computed tomography scan of pelvis showing a broad base mass in the right posterior-lateral wall of the urinary bladder

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Figure 6: Cystoscopic appearance of right posteriolateral wall growth

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Figure 7: Transurethral resection biopsy showed metastatic adenocarcinoma, identical to primary malignancy

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Metastatic tumors of the bladder are an unusual entity with reported incidence less than 3%.[3],[4] Being an organ in the pelvic cavity a structure with its close proximity is expected to give rise to secondaries. However, a primary gastric growth with synchronous UB metastasis is usually not expected. A Medline search revealed only one case reported from India by Sharma et al.[4] Klinger reviewed the reports of 5000 autopsies that were performed at Henry Ford Hospital as part of a study on secondary tumors of the genitourinary tract: Only 0.66% of the 5000 cases (33/5000) exhibited metastatic deposits of the adenocarcinoma in the bladder.[5] The precise mechanism responsible for distant bladder metastasis has not been elucidated so far. In our case, it was probably hematogenous. Most secondary lesions of the bladder are small and infiltrate the bladder wall without causing ulceration. In our case, the vesicle tumor was solitary, broad base and large (2.5 cm × 1.4 cm). Gastric outlet obstruction is the challenging aspect of the patient care and should be treated first because adequate oral intake is essential for systemic chemotherapy. In this case following palliative gastrojejunostomy, the patient received chemoradiation.

Although here we have reported synchronous metastasis with known primary gastric malignancy, but identical histology on TUR biopsy should be worked-up to search for a possible GI primary.


  Acknowledgment Top


I would like to acknowledge my wife Mrs. Payel Roy for giving me constant support while preparing the manuscript.



 
  References Top

1.
Roy S, Parwani AV. Adenocarcinoma of the urinary bladder. Arch Pathol Lab Med 2011;135:1601-5.  Back to cited text no. 1
    
2.
Konety BR, Carroll PR. Urothelial carcinoma: Cancers of the bladder ureter and renal pelvis. In: Tanagho EA, McAninch JW, editors. Smith's General Urology. 17th ed. New Delhi: Tata McGraw-Hill Publishing Company Limited; 2009. p. 310-1.  Back to cited text no. 2
    
3.
Wood DP. Urothelial tumor of the bladder. In: Wein AJ, editor. Campbell-Wash Urology. 10th ed. United States: Elsevier Saunders; 2010. p. 2316.  Back to cited text no. 3
    
4.
Sharma PK, Vijay MK, Das RK, Chatterjee U. Secondary signet-ring cell adenocarcinoma of urinary bladder from a gastric primary. Urol Ann 2011;3:97-9.  Back to cited text no. 4
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5.
Chang CL, Chen YT. Metastatic colon cancer to the urinary bladder: A case report. J Soc Colon Rectal Surg 2009;20:39-43.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

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