Presentation of case: Bladder cancer in an 18 year old female patient

Adenocarcinoma of Urinary Bladder With Distant Metastasis: Huge Fungating Tumor Eroding and Ripping-Off Through Suprapubic Region: A Rare Presentation

Adenocarcinoma of the urinary bladder is an extremely rare entity. It has aggressive behavior and it responds poorly to chemotherapy and radiotherapy. Painless hematuria and passage of clots are mainly common symptoms. Primary bladder adenocarcinoma has a poor prognosis due to its late presentation at an advanced stage. We present here, a rare case report of a 65-year-old male who presented with a huge ulcerative fungating tumor of clinical size 7 x 6 x 5 cm and radiological size 8.6 x 8.1 x 8 cm (exophytic component) and 3.6 x 3.3 x 3 cm (endophytic component) at suprapubic region eroding through pubic bone, rectus muscle and skin with features of lung and inguinal nodes metastasis. Wedge biopsy from fungating growth was suggestive of adenocarcinoma of the urinary bladder of papillary mucin secreting subtype which is also a very rare variant and subtype to get reported. It has a very poor prognosis and only a 6% of survival rate. Keeping all this context, due to poor Eastern Cooperative Oncology Group (ECOG) performance status, huge tumor burden, and advanced presentation of disease, it was suggested by the institutional tumor board, to provide him with the best palliative care management.

Giant bladder stone with squamous cell carcinoma of bladder: Case report and the literature review

INTRODUCTION AND IMPORTANCE

Concurrent bladder neoplasm and giant bladder stone are rare in contemporary urological practice. Squamous cell carcinoma (SCC) is rare histologic diagnosis of bladder cancer.

CASE PRESENTATION

A 45 y.o. male, with lower abdominal pain when urinating, that comes and goes in the last 35 years. He had gross hematuria a year ago. The patient comes from a rural region, which undiagnosed for years. Physical examination showed a suprapubic abdominal solid mass, sized 20 × 10 cm, without tenderness. On plain radiography, showed radiopaque lesion which fully occupies the bladder. The ultrasound showed bilateral hydronephrosis. The patient underwent vesicolithotomy, and a giant bladder stone (size of 14 × 9 cm) was found, with incidental finding of suspicious malignant mass. The patient refuses radical cystectomy. Due to mass characteristics that are manageable for complete excision and the need for histopathological studies, bladder preservative therapy was applied with complete tumor excision and biopsy. The mass pathological diagnosis is grade 2 squamous cell carcinoma with lamina muscularis invasion, staged pT3bN0M0. The patient underwent cisplatin-based chemotherapy, with regular evaluation. The possibility of future radical cystectomy remains open.

CLINICAL DISCUSSION

By diameter, the stones found in our patient is perhaps one of the largest that ever reported being associated with bladder SCC. The bladder stones causing chronic mucosal injury, lead to the development of SCC. In limited situation, bladder preservation therapy may be considered for muscle-invasive bladder cancer.

CONCLUSION

Despite its rarity, SCC along with the chronic bladder stone is possible, and needs more attention.

Enterovesical fistula secondary to transitional cell carcinoma of the bladder in a 20 years old patient: A rare entity

Bladder cancers are not very common in young people under 20 years, especially with an atypical presentation such as faecaluria due to enterovesical fistula.

This report describes the case of a 20 years old man who was diagnosed with a mass involving the small intestine and bladder during the course of investigations for faecaluria and abdominal pain. Histopathological examination of the biopsies during cystoscopy revealed: muscle invasive transitional cell carcinoma, while the computerized tomography scan had confirmed the enterovesical fistula.

The patient was traited by Radical cystectomy with extended pelvic lymph node dissection and ileocecal resection as ultimate curative treatment.

Somatic Mutations Profile of a Young Patient With Metastatic Urothelial Carcinoma Reveals Mutations in Genes Involved in Ion Channels

Background: Urothelial carcinoma is the most common malignancy of the bladder and is primarily considered as a disease of the elderly. Studies that address bladder tumor occurrence in young age groups are rare.

Case Presentation: A 19-year-old male presented with a gross total painless hematuria. A histology after biopsy revealed a high-grade transitional cell carcinoma with lymph node metastasis. The patient succumbed to the disease on day 72 of the treatment. Here, we used whole-exome sequencing of a paired tumor-normal sample to identify the somatic mutations and the possible targets of treatment.

Result: We predicted eight potential driver mutations (TP53 p.V157L, RB1 c.1498+1G>T, MED23 p.L1127P, CTNND1 p.S713C, NSD1 p.P2212A, MED17 p.G556V, DPYD p.Q814K, and SPEN p.S1078^*). In addition, we predicted deleterious mutations in genes involved in the ion channels (CACNA1S p.E1581K, CACNG1 p.P71T, CACNG8 p.G404W, GRIN2B p.A1096T, KCNC1 p.G16V, KCNH4 p.E874K, KCNK9 p.R131S, P2RX7 p.A296D, and SCN8A p.R558H).

Conclusions: Most likely, mutations in genes involved in ion channels may be responsible for the aggressive behavior of a tumor. Ion channels are the second largest class of drug targets, and may thus serve as a putative potential therapeutic target in advanced stage urothelial carcinoma.

Urothelial neoplasm in a 19-year-old male patient with urine discoloration, negative lab, and imaging workup: Should we investigate the findings or the symptom?

With few cases of PUNLMPs in young adults being reported in the literature, we hope to raise clinical awareness of prompt and effective diagnosis, while maintaining a high index of suspicion among health professionals. Even in the absence of red blood cells in the urine and subsequent negative imaging workup, clinicians should not delay performance of diagnostic cystoscopy.