Bladder urothelial carcinoma extending to rectal mucosa and presenting with rectal bleeding

Table 3 Metastases of urothelial bladder carcinoma to the esophagus, stomach, and small intestine

Patient age and sex	Prior oncologic history	Clinical presentation with GI involvement	Radiologic imaging, endoscopy, surgery	Metastasis location: Pathologic diagnosis	Treatment	Outcome	Ref.
1. 55-year-old man	1 mo PTA underwent total cystoprostatectomy, bilateral ilio-obturator lymphadenectomy, and bladder reconstruction for bladder urothelial carcinoma pT3-GIII, N0	Hematemesis 8 d after surgery	Chest and abdominopelvic CT: Esophageal mass. EGD: 2-cm-wide mass in proximal esophagus. EUS: No lymphadenopathy	Esophagus: Urothelial carcinoma infiltrating submucosa	Chemotherapy with M-VAC, and RT of metastasis	Developed radiation pericarditis but recovered. Alive at 2 yr	Jung et al[15]
2. 66-year-old man	No prior oncologic history	Dysphagia, anorexia, weight loss, headaches, and lightheadedness for 6 wk. Palpable, tender, 2 cm mass on left neck	Neck and thoracic CT: 3 cm × 2 cm soft tissue mass with dilation and thickening of proximal esophagus. EGD: Focal stricture at 25 cm from incisors with a 2 cm × 1 cm ulcer with irregular margins	Esophagus: Poorly differentiated urothelial carcinoma	None	Died 10 d after discharge from hospital	Dy et al[16]
3. 80-year-old man	Four years PTA underwent RT and chemotherapy (after declining radical cystectomy) for bladder urothelial carcinoma. Three years PTA underwent lung lobe wedge resection for solitary lung metastasis. 1 mo PTA had a normal EGD and colonoscopy in evaluation of anemia	Malaise, dizziness, dyspnea, melena. Rectal exam: Positive occult blood in stool. Hemoglobin = 5.4 g/dL	Small bowel enteroscopy: 3 cm, ulcerated, infiltrating tumor in distal duodenum. Tumor has an adherent, friable, clot	Duodenum: High-grade urothelial carcinoma	Duodenectomy and duodenomy jejunostomy	PET scan 2 mo later: Metastases to liver and lungs. Patient expired soon thereafter from cardiac arrhythmia	Girotra et al[17]
4. 62-year-old man	Two years PTA underwent partial cystectomy with lymph node dissection and adjuvant chemotherapy for stage IIIb bladder urothelial carcinoma	Hematemesis, hemoglobin = 7.0 g/dL	EGD: Large bleeding mass in descending duodenum. Treated with proton pump inhibitor therapy. Repeat EGD 4 d later: large partly obstructing, 7-cm-long mass in descending duodenum	Duodenum: Poorly differentiated urothelial carcinoma	Palliative radiation	Died 6 wk later	Chan et al[18]
5. 74-year-old man	Four years PTA underwent exploratory laparotomy which demonstrated nodal metastasis. Completed preoperative chemotherapy, but declined surgical resection	Abdominal pain, bloating, distention, nausea, and vomiting	Serial pelvic CT (to monitor cancer progression): Stable bladder wall thickening Small bowel barium contrast radiography: Narrowing of third portion of duodenum Gastroscopy: Fluid-filled, dilated, stomach without obstruction. EGD: Luminal narrowing with overlying normal mucosa in third portion of duodenum. EUS: Circumferential wall thickening	Duodenum: urothelial carcinoma	Enteral stent and palliative chemotherapy	Died 9 mo later	Yusuf et al[13]
6. 42-year-old woman	No prior oncologic history	Nausea, vomiting, abdominal discomfort, and 6-kg weight loss for 2 mo	Barium meal: Abrupt stricture at junction between second and third portion of duodenum. Abdominopelvic CT: Infiltrative soft tissue mass around duodenum, calcified bladder wall. No pelvic lymphadenopathy. EGD: Gastric outlet obstruction with distorted and erythematous duodenum without ulceration, or mucosal tumor	Duodenum: Micropapillary variant of poorly differentiated urothelial carcinoma	Duodenal stent and RT to periduode-nal lesion. Administered palliative gemcitabine and carboplatin	Died 15 mo after diagnosis	Hawtin et al[19]
7. 87-year-old man	Sixteen months PTA underwent TURBT for grade 3, pT2bN0M0, bladder urothelial carcinoma	Ileus	Abdominopelvic CT: Pneumoperitoneum due to GI perforation Laparotomy: Elastic hard tumor at site of ileal perforation	Ileum: Metastatic urothelial carcinoma	Partial resection of ileum	NA	Hoshi et al[20] (in Ja-panese)
8. 53-year-old man	No prior oncologic history	Gross hematuria	Abdominopelvic CT: Bladder tumor invading prostate. Cystoscopy: Non-papillary, broad based, tumor in right wall of bladder	Ileum and prostate: Urothelial carcinoma pT4aN1M0	Total cystec--tomy and creation of ileal conduit. Neoadjuvant chemotherapy	NA	Hoshi et al[20] (article in Japanese)
9. 56-year-old man	Fifty-nine months PTA underwent TURBT for bladder urothelial carcinoma	Abdominal pain and GI perforation	NA	Small intestine, lymph nodes, lung, and liver: Urothelial carcinoma	NA	NA	Hoshi et al[20] (Case from table 2)
10. 63-year-old woman	Seven months PTA underwent total cystectomy for pT3b bladder urothelial carcinoma	Abdominal pain	NR	Small intestine: Urothelial carcinoma	NR	NR	Hoshi et al[20] (Case from table 2)
11. 46-year-old man	Thirty-eight months PTA underwent RT and chemotherapy for pT3b bladder urothelial carcinoma	Ileus	NR	Small intestine: Urothelial carcinoma	NR	NR	Hoshi et al[20] (Case from table 2)
12. 71-year-old man	Thirty-six months PTA underwent total cystectomy for bladder urothelial carcinoma	Melena and anemia	NR	Small intestine: Urothelial carcinoma	NR	NR	Hoshi et al[20] (Case from table 2)
13. 55-year-old man	Seven years PTA underwent total cystectomy, pelvic lymphadenectomy, and neobladder reconstruction. Underwent two cycles of adjuvant chemotherapy for pT3apN0 G2 bladder urothelial carcinoma	Massive melena, HR = 120 beats/min, BP = 72/36 mmHg. Hemoglobin = 7.9 g/dL	Abdominopelvic CT: Right hydronephrosis from external iliac lymph node metastasis invading ileum. Angiography: Right external iliac artery successfully embolized using microcoils and n-butyl cyanoacrylate. Then developed ischemic colitis, treated with iliac artery bypass grafting, and right common and internal iliac artery embolization	Ileum: NR	Three cycles of unspecified chemotherapy	Died 4 mo after embolization	Honda et al[21]

BC: Bladder cancer; BP: Blood pressure; CT: Computed tomography; EGD: Esophagogastroduodenoscopy; GI: Gastrointestinal, HR: Heart rate; M-VAC: Methotrexate, vinblastine, Adriamycin; NR: Not reported; PTA: Prior to admission; RT: Radiation therapy; TURBT: Transurethral resection of bladder tumor; EUS: Endoscopic ultrasound.