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Zhang S, Han Z, Qi H, Zhang Z, Zheng Z, Duan X. Machine learning assisted microfluidics dual fluorescence flow cytometry for detecting bladder tumor cells based on morphological characteristic parameters. Anal Chim Acta 2024; 1317:342899. [PMID: 39030022 DOI: 10.1016/j.aca.2024.342899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Bladder cancer (BC) is the most common malignant tumor and has become a major public health problem, leading the causes of death worldwide. The detection of BC cells is of great significance for clinical diagnosis and disease treatment. Urinary cytology based liquid biopsy remains high specificity for early diagnosis of BC, however, it still requires microscopy examination which heavily relies on manual operations. It is imperative to investigate the potential of automated and indiscriminate cell differentiation technology to enhance the sensitivity and efficiency of urine cytology. RESULTS Here, we developed a machine learning algorithm empowered dual-fluorescence flow cytometry platform (μ-FCM) for urinary cytology analysis. A phenotype characteristic parameter (CP) which correlated with the size of the cell and nucleus was defined to achieve the differentiation of the BC cells and uroepithelial cells with high throughput and high accuracy. Based on CP analysis, SV-HUC-1 cells were almost differentiated from EJ cells and effectively reduced the overlap with 5637 cells. To further differentiate SV-HUC-1 cells and 5637 cells, support vector machine (SVM) machine learning algorithm was optimized to assist data analysis with the highest accuracies of 84.7 % for cell differentiation including the specificity of 91.0 % and the sensitivity of 75.0 %. Furthermore, the false positive rate (FPR) compensation enabled the detection rates of rare BC cells predicted by the well-trained SVM model were close to the true proportions with the recognition error in 0.4 % for the tumor cells. SIGNIFICANCE As a proof of concept, the developed μ-FCM system successfully demonstrates the capacity to identify the distribution of exfoliated cells in real urine samples. This system underscores the significance of integrating AI with microfluidics to perform high-throughput phenotyping of exfoliated cells, offering a pathway toward scalable, efficient, and automatic microfluidic systems in the fields of both biosensing and in vitro diagnosis of BC.
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Affiliation(s)
- Shuaihua Zhang
- State Key Laboratory of Precision Measuring Technology & Instruments, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Ziyu Han
- State Key Laboratory of Precision Measuring Technology & Instruments, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Hang Qi
- State Key Laboratory of Precision Measuring Technology & Instruments, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China
| | - Zhihong Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Zhiwen Zheng
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230032, China; Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Xuexin Duan
- State Key Laboratory of Precision Measuring Technology & Instruments, School of Precision Instrument and Opto-electronics Engineering, Tianjin University, Tianjin, 300072, China.
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2
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Liu Y, Dong X, Li T, Xing Y, Liu N. Lung adenocarcinoma with bladder metastasis: A case report and literature review. Front Oncol 2023; 13:1202885. [PMID: 37476383 PMCID: PMC10354362 DOI: 10.3389/fonc.2023.1202885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Background Lung cancer is the most common cause of cancer-related mortality in the world. Unfortunately, more than 50% of patients have already metastasized at the time of diagnosis, contributing to morbidity and mortality. Common sites of metastasis are adrenal glands, liver, bone, and brain. Bladder metastasis is rare and should prompt a careful differential consideration of primary bladder cancer. Case description Here, we report a 72-year-old female who went to the hospital for "gross hematuria for one day". Cystoscopy showed space-occupying lesions in the bladder. During the general CT examination, space-occupying lesions in the lower lobe of the lung were found. Peripheral lung cancer with multiple lymph node metastases, pulmonary metastasis, and left pleural effusion were considered. Transurethral cystoscopic resection of the bladder tumor and pleural effusion cell block examination were performed to clarify the diagnosis. Combined with morphological and immunohistochemical results, both pathological results supported a diagnosis of lung adenocarcinoma metastasis, and gene detection was carried out. EGFR, ALK, and ROS-1 were negative. According to the genetic testing results, there was no corresponding targeted drug, so we administered chemotherapy, and one-year survival was achieved, which was better than expected based on other studies. Conclusion This paper describes a case of lung adenocarcinoma metastatic to the bladder and includes a review of the literature to provide clinicians with diagnostic and treatment experience and help avoid misdiagnosis and mistreatment.
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Affiliation(s)
- Yuying Liu
- Department of Oncology, Qilu Hospital of Shandong University, Dezhou Hospital, Dezhou, Shandong, China
| | - Xinyue Dong
- Department of Oncology, Qilu Hospital of Shandong University, Dezhou Hospital, Dezhou, Shandong, China
| | - Tao Li
- Department of Oncology, Qilu Hospital of Shandong University, Dezhou Hospital, Dezhou, Shandong, China
| | - Yanke Xing
- Department of Oncology, Qilu Hospital of Shandong University, Dezhou Hospital, Dezhou, Shandong, China
| | - Na Liu
- Department of Pathology, Qilu Hospital of Shandong University, Dezhou Hospital, Dezhou, Shandong, China
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3
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Jin CB, Yang L. Bladder metastasis from epidermal growth factor receptor mutant lung cancer: A case report. World J Clin Cases 2023; 11:3356-3361. [PMID: 37274049 PMCID: PMC10237138 DOI: 10.12998/wjcc.v11.i14.3356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Bladder metastasis from lung cancer with epidermal growth factor receptor (EGFR) mutation is extremely rare. Here, we report a case of bladder metastasis from lung adenocarcinoma with EGFR mutation.
CASE SUMMARY A 53-year-old female patient was diagnosed with advanced lung adenocarcinoma with EGFR exon 19 deletion. Multiple nodules on the bladder wall were found by regular examination of the pelvic cavity through computed tomography during targeted therapy. Further cystoscopy and histological examination of bladder biopsy tissues confirmed the bladder metastasis from lung adenocarcinoma. In addition, genetic analysis of the bladder metastasis revealed EGFR T790M mutation. The patient achieved a good response to a third-generation EGFR tyrosine kinase inhibitor.
CONCLUSION During routine follow-up of lung cancer patients, imaging examination of the pelvic cavity should be performed to avoid missing bladder metastasis. The ultimate diagnosis of bladder metastasis sill depends on the pathological result of biopsy tissues.
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Affiliation(s)
- Cai-Bao Jin
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan 430000, Hubei Province, China
| | - Ling Yang
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan 430000, Hubei Province, China
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Gholami L, Ivari JR, Nasab NK, Oskuee RK, Sathyapalan T, Sahebkar A. Recent Advances in Lung Cancer Therapy Based on Nanomaterials: A Review. Curr Med Chem 2023; 30:335-355. [PMID: 34375182 DOI: 10.2174/0929867328666210810160901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/22/2022]
Abstract
Lung cancer is one of the commonest cancers with a significant mortality rate for both genders, particularly in men. Lung cancer is recognized as one of the leading causes of death worldwide, which threatens the lives of over 1.6 million people every day. Although cancer is the leading cause of death in industrialized countries, conventional anticancer medications are unlikely to increase patients' life expectancy and quality of life significantly. In recent years, there are significant advances in the development and applications of nanotechnology in cancer treatment. The superiority of nanostructured approaches is that they act more selectively than traditional agents. This progress led to the development of a novel field of cancer treatment known as nanomedicine. Various formulations based on nanocarriers, including lipids, polymers, liposomes, nanoparticles and dendrimers have opened new horizons in lung cancer therapy. The application and expansion of nano-agents lead to an exciting and challenging research era in pharmaceutical science, especially for the delivery of emerging anti-cancer agents. The objective of this review is to discuss the recent advances in three types of nanoparticle formulations for lung cancer treatments modalities, including liposomes, polymeric micelles, and dendrimers for efficient drug delivery. Afterward, we have summarized the promising clinical data on nanomaterials based therapeutic approaches in ongoing clinical studies.
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Affiliation(s)
- Leila Gholami
- Nanotechnology Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jalil Rouhani Ivari
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Niloofar Khandan Nasab
- Department of Medical Biotechnology and Nanotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Kazemi Oskuee
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, United Kingdom of Great Britain and Northern Ireland
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran.,School of Medicine, The University of Western Australia, Perth, Australia.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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5
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Zaghbib S, Chakroun M, Saadi A, Boussaffa H, Znaidi N, Rammeh S, Ayed H, Chebil M. Isolated bladder metastasis from lung adenocarcinoma: a case report. J Surg Case Rep 2021; 2021:rjab195. [PMID: 34055288 PMCID: PMC8159194 DOI: 10.1093/jscr/rjab195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 11/12/2022] Open
Abstract
Cancers of extra bladder origin represent between 2 and 12% of bladder neoplasms and are most often secondary to contiguous bladder invasion. Metastasis from distant organs is exceptional, especially from pulmonary adenocarcinoma with <10 cases identified over the last 20 years. We report here a new case of a 55-year-old patient with a recently diagnosed pulmonary adenocarcinoma referred to the urology department for macroscopic hematuria. Computed tomography scan showed, in addition to the lung mass of the right lower lobe with a right mediastinal adenopathy, a thickening of the right lateral bladder wall. Cystoscopy showed inflammatory lesions on the bladder mucosa, which biopsy with immunohistochemical examination revealed to be tumoral proliferation in the lamina propria realizing the same immunohistochemical profile of the primary lung tumor (CK7+/TTF1+/CK20-/PSA-). The patient was treated with palliative platinum-based chemotherapy and unfortunately died 5 months after diagnosis.
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Affiliation(s)
- Selim Zaghbib
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Ahmed Saadi
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hamza Boussaffa
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Nadia Znaidi
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Haroun Ayed
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Chebil
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia
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6
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Kirisawa T, Okada M, Miura C, Miura I. Bladder metastasis without hematuria, following radiation therapy for lung adenocarcinoma. Int Cancer Conf J 2021; 10:248-253. [PMID: 34221841 PMCID: PMC8206304 DOI: 10.1007/s13691-021-00490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022] Open
Abstract
Bladder metastasis from lung adenocarcinoma is extremely rare. Unlike primary bladder urothelial tumors, the initial symptoms of this disease vary, and include pelvic pain, dysuria, and hematuria. There are few reports on cases without microscopic hematuria. An 86-year-old woman with a previous history of radiation therapy for lung adenocarcinoma complained of urinary frequency. A urinalysis was negative for hematuria and pyuria; thus, overactive bladder was suspected. However, the patient’s symptom worsened considerably, and cystoscopy revealed bladder tumor. Transurethral resection of the bladder tumor was performed. Based on the histological, immunohistochemical examination and clinical history, the final pathological diagnosis was bladder metastasis from lung adenocarcinoma. The patient died 19 days after the operation due to severe disease progression. In this rare case, a patient with bladder metastasis from lung adenocarcinoma did not show microscopic hematuria. Cystoscopy and computed tomography helped to make a rapid and accurate diagnosis.
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Affiliation(s)
- Takahiro Kirisawa
- Department of Urology, Hokkaido Social Work Association Obihiro Hospital, 2 Higashi 5-jo Minami 9-chome, Obihiro-shi, Hokkaido, Japan
| | - Manabu Okada
- Department of Urology, Hokkaido Social Work Association Obihiro Hospital, 2 Higashi 5-jo Minami 9-chome, Obihiro-shi, Hokkaido, Japan
| | - Chisako Miura
- Department of Pathology, Hokkaido Social Work Association Obihiro Hospital, 2 Higashi 5-jo Minami 9-chome, Obihiro-shi, Hokkaido, Japan
| | - Ichiro Miura
- Department of Pathology, Hokkaido Social Work Association Obihiro Hospital, 2 Higashi 5-jo Minami 9-chome, Obihiro-shi, Hokkaido, Japan
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7
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Sanguedolce F, Calò B, Mancini V, Zanelli M, Palicelli A, Zizzo M, Ascani S, Carrieri G, Cormio L. Non-Muscle Invasive Bladder Cancer with Variant Histology: Biological Features and Clinical Implications. Oncology 2021; 99:345-358. [PMID: 33735905 DOI: 10.1159/000514759] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The most common bladder cancer (BC) histotype is pure urothelial carcinoma (UC), which may undergo divergent differentiation in some cases. Variant histology (VH) presents along variable morphologies, either single or combined between them or with pure UC. From a clinical standpoint, the vast majority of BC is diagnosed at non-invasive or minimally invasive stages, namely as non-muscle invasive BC (NMIBC). There is a wide range of therapeutic options for patients with NMIBC, according to their clinical and pathological features. However, current risk stratification models do not show optimal effectiveness. Evidence from the literature suggests that VH has peculiar biological features, and may be associated with poorer survival outcomes compared to pure UC. SUMMARY In order to describe the biological features and prognostic/predictive role of VH in NMIBC, and to discuss current treatment options, we performed a systematic literature search through multiple databases (PubMed/Medline, Google Scholar) for relevant articles according to the following terms, single and/or in combination: "non-muscle invasive bladder cancer," "variant histology," "micropapillary variant," "glandular differentiation," "squamous differentiation," "nested variant," "plasmacytoid variant," and "sarcomatoid variant." We extracted 99 studies including original articles, reviews, and systematic reviews, and subsequently analyzed data from 16 studies reporting on the outcome of NMIBC with VH. We found that the relative rarity of these forms as well as the heterogeneity in study populations and therapeutic protocols results in conflicting findings overall. Key Messages: The presence of VH should be taken into account when counseling a patient with NMIBC, since it may upgrade the disease to high-risk tumor and thus warrant a more aggressive treatment.
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Affiliation(s)
| | - Beppe Calò
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
| | - Vito Mancini
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
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8
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Li X, Zhang L, Zeng L, Wang X, Song W, Zhong D. Difficult differential diagnosis of bladder pedicled masses about metastasis from non-small cell lung cancer: A case report. Cancer Biol Ther 2021; 22:106-111. [PMID: 33612067 DOI: 10.1080/15384047.2020.1840885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Differential diagnoses of primary bladder tumors from metastasis ones can be difficult, for the symptom and imaging findings are pretty similar. Here, we reported a case of bladder metastasis from lung adenocarcinoma. A 73-year-old female patient who was diagnosed with bladder metastasis from lung adenocarcinoma presented as gross hematuria and multiple pedicled masses in the bladder on MRI scan. Such clinical manifestations were easily misdiagnosed as primary bladder malignancy. Additionally, the tumor samples of this case were further harvested and processed for histopathological analysis and gene detections to confirm this case as a metastasis tumor that was refractory to the subsequent therapy. Diagnosis of bladder metastasis should be paid more consideration in patients with a history of cancer despite the fact that primary bladder malignancy accounts for the majority of bladder masses.
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Affiliation(s)
- Xiaoqing Li
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China.,Phase I Clinical Trial Department, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Linlin Zhang
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lili Zeng
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Wang
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjing Song
- Department of Pathology, Tianjin Medical University, Tianjin, China
| | - Diansheng Zhong
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
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9
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Bladder cancer and its mimics: a sonographic pictorial review with CT/MR and histologic correlation. Abdom Radiol (NY) 2019; 44:3827-3842. [PMID: 31676920 DOI: 10.1007/s00261-019-02276-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bladder cancer is the most common cancer of the urinary system and often presents with hematuria. Despite its relatively high incidence, bladder cancer is often under-recognized sonographically. Moreover, even when bladder abnormalities are identified, numerous other entities may mimic the appearance of bladder cancer. Given the incidence and prevalence of bladder cancer, it is important to recognize its variable appearance sonographically and distinguish it from its common mimics. We review the sonographic appearance of bladder cancer and its mimics, providing correlative CT/MR imaging as well as pathology. We stress the importance and advantage of ultrasound as a dynamic imaging modality, with the ability to optimize distinguishing bladder cancer from similar-appearing entities.
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10
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Sanguedolce F, Russo D, Calò B, Cindolo L, Carrieri G, Cormio L. Diagnostic and prognostic roles of CK20 in the pathology of urothelial lesions. A systematic review. Pathol Res Pract 2019; 215:152413. [PMID: 30987832 DOI: 10.1016/j.prp.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/23/2019] [Accepted: 04/05/2019] [Indexed: 12/15/2022]
Abstract
Cytokeratin 20 (CK20) is one of the most common immunohistochemical markers in the routine practice of a pathology lab, as biopsies from the urinary tract encompass a wide spectrum of lesions which may pose issues in their detection and classification. In this review, we aim to outline the diagnostic accuracy and prognostic value of CK20 in flat urothelial lesions, papillary non-invasive and invasive urothelial carcinoma, molecular subgroups and variant histology, and we briefly discuss its limitations and potential pitfalls.
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Affiliation(s)
| | - Davide Russo
- Department of Pathology, University Hospital, Foggia, Italy
| | - Beppe Calò
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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11
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Cormio L, Mancini V, Calò B, Selvaggio O, Mazzilli T, Sanguedolce F, Carrieri G. Asymptomatic solitary bladder plasmocytoma: A case report and literature review. Medicine (Baltimore) 2017; 96:e9347. [PMID: 29390408 PMCID: PMC5815820 DOI: 10.1097/md.0000000000009347] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Solitary extramedullary plasmocytoma may arise in any organ, either as a primary tumor or as part of a systemic myeloma; if it rarely affects bladder, it presents with urinary symptoms. We describe the first case of asymptomatic BP occasionally diagnosed in a patient with ascites. PATIENT CONCERNS A 74-year-old woman with hepatitis C virus (HCV)-related liver cirrhosis presented with ascites and no urinary or other symptoms. DIAGNOSES Routine blood tests were within normal ranges, except for mild elevation of transaminases due to chronic hepatitis. Abdominal ultrasound and computed tomography (CT) scanning showed multiple liver nodules suspected for carcinomas and, incidentally, a 18 mm solid lesion of right bladder wall. OUTCOMES She underwent transurethral resection of the bladder tumor and percutaneous liver biopsies; final diagnosis was solitary bladder plasmocytoma (BP) and hepatocellular carcinoma (HCC), respectively. She was given chemoembolization of the main HCC nodule but no adjuvant treatment for BP. At 3-month follow-up, total-body CT showed no signs of bladder disease nor distant metastases; unfortunately, she died one month later due to liver failure. LESSONS This is the first reported case of asymptomatic BP. This rare neoplasm may pose difficulties in differential diagnosis with both bladder metastases and the plasmocytoid variant of bladder transitional cell carcinoma. We also highlighted lack of factors predicting disease outcome as well as response to potential adjuvant treatments.
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Affiliation(s)
| | | | - Beppe Calò
- Department of Urology and Renal Transplantation
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