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Table of Contents
CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 3  |  Page : 218-219  

Urothelial carcinoma of the bladder with asynchronous metastases to both testes


1 Department of Surgery, University of Melbourne, Victoria, Australia
2 Department of Surgery, University of Melbourne; Ludwig Institute for Cancer Research, Austin Hospital, Heidelberg, Victoria, Australia

Date of Submission05-Oct-2011
Date of Acceptance29-Jan-2012
Date of Web Publication29-Jul-2013

Correspondence Address:
Nathan Lawrentschuk
145 Studley Road, Heidelberg Victoria, 3084
Australia
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DOI: 10.4103/0974-7796.115743

PMID: 24049392

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   Abstract 

Urothelial carcinoma (UC) or transitional cell carcinoma (TCC) of the bladder has a high likelihood of metastasis, and the more common sites of distant metastasis are bone, liver and lung. Metastasis to the testis is extremely rare. We identified five cases of bladder UC metastasing to the testis in the literature, none of which occurred bilaterally. We present this case of asynchronous UC metastases to both testes as the first report in the literature. Metastatic disease should be considered as a potential differential diagnosis for testicular tumors arising in patients with a history of UC.

Keywords: Asynchronous, metastasis, testes, urothelial carcinoma


How to cite this article:
Kiely G, Kavanagh L, Bolton D, Lawrentschuk N. Urothelial carcinoma of the bladder with asynchronous metastases to both testes. Urol Ann 2013;5:218-9

How to cite this URL:
Kiely G, Kavanagh L, Bolton D, Lawrentschuk N. Urothelial carcinoma of the bladder with asynchronous metastases to both testes. Urol Ann [serial online] 2013 [cited 2020 Nov 28];5:218-9. Available from: https://www.urologyannals.com/text.asp?2013/5/3/218/115743


   Introduction Top


Muscle-invasive urothelial carcinoma (UC) of the bladder is an aggressive malignancy with a high likelihood of metastasis. The most common sites of distant metastasis of UC are bone, liver and lung. [1],[2] UC spread to the testis is rare. We report a case of asynchronous metastases of superficial bladder UC to both testes.


   Case Report Top


A 71-year-old male presented with clot retention, with a large bladder mass consistent with UC identified by cystoscopy and subsequently fully resected via transurethral resection of bladder tumor (TURBT). Histology confirmed invasive (G3T2) UC with squamous differentiation. CT staging at the time [Figure 1] revealed a right upper lobe pulmonary nodule of 15 × 15 mm, and a fine needle aspirate confirmed malignant cells. A fluorodeoxyglucose (FDG) study demonstrated uptake only within the pulmonary lesion.
Figure 1: Ultrasound of the left testis demonstrating a mixed solid-cystic lesion

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Treatment was initiated using 66 Gy radiotherapy plus gemcitabine-based chemotherapy. A reduction in the size of the lung metastasis was noted on subsequent FDG PET (PET: Positron emission tomography) scanning.

Approximately one year after his initial presentation, the patient noted painless swelling of his left testicle. Ultrasound [Figure 2] confirmed a mixed solid cystic lesion, which was treated by a left inguinal orchidectomy. Histology revealed metastatic UC. At that time, the right testis was normal; however, nine months later, he re-presented with a similar painless swelling in the other testicle and later went on to have a right inguinal orchidectomy. Serum tumor markers at both presentations were negative. Histology again confirmed metastatic UC, with squamous differentiation. The patient thereafter received three-monthly testosterone replacement. On repeat staging computerized tomography (CT), mediastinal lymphadenopathy was noted, but there was no other evidence of metastasis [Figure 3].
Figure 2: Histopath (a) (x4 ) and (b) (x20) of Testis specimen showing TCC infiltration

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Figure 3: (a) Staging CT at presentation demonstrating bladder TCC (marked). (b) Staging CT at presentation demonstrating initial pulmonary metastasis (marked)

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Subsequently, four-month surveillance CT revealed that the patient's disease had progressed with metastatic disease developing in pulmonary and paratracheal tissue. Ultrasound-guided biopsy confirmed urothelial origin. Despite further systemic chemotherapy, the patient died approximately two years after his initial presentation.


   Discussion Top


Metastatic tumors of the testis are extremely rare. Solid tumors reported to metastasize to the testis include the prostate, lung, melanoma, and kidney. [3] The largest retrospective study of secondary neoplasms of the testis identified leukemia as the most common origin, and a review of 10 years' experience at the Mayo Clinic detected 20 cases of metastatic carcinoma of the testis, but no cases of metastatic UC of the testis were identified in either of these series. [4],[5] We have identified five published reports of confirmed UC metastases of the testis, none of which was bilateral. [3],[6],[7],[8],[9]

The immunoprotective effect of the blood-testis barrier is thought to help limit the potential for metastatic deposits to this site. This same phenomenon may paradoxically limit the immune response and chemotherapeutic access to established metastatic deposits within the testes, permitting the relatively rapid growth of these lesions in this instance. [10]

Metastatic disease should be considered as a potential differential diagnosis for testicular tumors arising in patients with a history of UC.

 
   References Top

1.Stenzl A, Cowan NC, De Santis M, Jakse G, Kuczyk MA, Merseburger AS, et al. The updated EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 2009;55:815-25.  Back to cited text no. 1
[PUBMED]    
2.Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin ME, Van den Abbeele AD. Metastatic pattern of bladder cancer: Correlation with the characteristics of the primary tumor. AJR Am J Roentgenol 2011;196:117-22.  Back to cited text no. 2
[PUBMED]    
3.Morgan K, Srinivas S, Freiha F. Synchronous solitary metastasis of transitional cell carcinoma of the bladder to the testis. Urology 2004;64:808-9.  Back to cited text no. 3
    
4.Dutt N, Bates AW, Baithun SI. Secondary neoplasms of the male genital tract with different patterns of involvement in adults and children. Histopathology 2000;37:323-31.  Back to cited text no. 4
[PUBMED]    
5.Patel SR, Richardson RL, Kvols L. Metastatic cancer to the testes: A report of 20 cases and review of the literature. J Urol 1989;142:1003-5.  Back to cited text no. 5
[PUBMED]    
6.Mahmalji W, Jain S, Stower M. A rare cause of scrotal swelling: Transitional cell carcinoma of the bladder presenting as a testicular metastasis. Adv Urol 2011;2011:284121.  Back to cited text no. 6
[PUBMED]    
7.Thwaini A, Kaluba J, Shergill I, Kumar R, Lewi H. Testicular metastasis of transitional cell carcinoma of the urinary bladder: An unusual site. Int J Urol 2006;13:1136-7.  Back to cited text no. 7
[PUBMED]    
8.Binkley WF, Seo IS. Metastatic transitional cell carcinoma of the testis. A case report. Cancer 1984;54:575-8.  Back to cited text no. 8
[PUBMED]    
9.Negelev S, Paz A, Segal M. Testicular metastasis from transitional cell carcinoma of the bladder. Harefuah 1995;128:90-1.  Back to cited text no. 9
[PUBMED]    
10.Bart J, Groen, HJ, van der Graaf WT, Hollema H, Hendrikse NH, Vaalburg W, et al. An oncological view on the blood-testis barrier. Lancet Oncol 2002;3:357-63.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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