Bladder carcinoma recurrence post-cystectomy simulating rectal carcinoma

Clinicopathologic characteristics and overall survival in patients with bladder cancer involving the gastrointestinal tract

Involvement of the gastrointestinal (GI) tract by bladder cancer is rare and documented in only a few case reports with no prognostic information available. The aim of this study was to clinicopathologically characterize patients with pathologically proven bladder cancer in the GI tract. We reviewed pathology reports from cystectomy patients at our institution from 2006 to 2011, identifying those with GI involvement at or after cystectomy. Overall survival (OS) was analyzed using Kaplan-Meier curves and Cox proportional hazard regression models. Twelve patients had surgical pathology specimens with GI involvement (anus, rectum, colon, and small bowel) at (n = 11) or within 4 months (n = 1) of cystectomy. These patients were noted to be pathologically staged inconsistently. GI involvement was a negative predictor of survival, with a 1.5-year OS of 25 versus 62 % without GI involvement (P < 0.001), similar to our pT4 patients (OS 26 %). In node-negative patients, there was a significantly worse 1.5-year OS with GI involvement compared to those without tumor in the GI tract (P = 0.005). We provide the first case series of patients with bladder cancer in the GI tract. GI involvement is a strong negative predictor of survival and behaves comparable to pT4 patients. However, we recommend that pathologists adhere to the current pT staging guidelines, in which GI involvement is not a criterion, until further research is conducted illustrating if and how it should be incorporated.

Metastatic Bladder Cancer Presenting as Duodenal Obstruction

Introduction: Bladder cancer is a common malignancy but presentation with metastatic disease is rare. This is the first reported case of duodenal obstruction as a presentation of metastatic bladder cancer. Clinical Picture: Amiddle-aged woman presented with nausea, vomiting, weight loss and intermittent haematuria. Radiology and histology confirmed metastatic bladder cancer to the retroperitoneum encasing the duodenum and causing obstruction. Treatment: Insertion of a duodenal stent relieved the obstruction and palliative chemoradiotherapy was initiated. Outcome: The patient died 15 months after diagnosis. Conclusions: Clinicians and radiologists should be aware of atypical presentations of common malignancies.