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Bladder carcinoma in a 31-year-old female spina bifida patient with an auto-augmented bladder.

Veenboer PW, de Kort LM - Int Urol Nephrol (2011)

Bottom Line: However, only 10 months after the onset of her symptoms, she died after major lymphatic metastases had developed in the small pelvis.This case report is the first on an adult spina bifida patient developing bladder carcinoma after detrusorectomy.The latter could have serious implications on the prognosis of these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Medical Centre Utrecht (UMC Utrecht), Heidelberglaan 100, Huispostnr. C.04.236, 3584 CX Utrecht, The Netherlands. p.w.veenboer@students.uu.nl

ABSTRACT
We present the case of a 31-year-old spina bifida patient presenting with a poorly differentiated T3N1M0 bladder carcinoma with sarcomatoid differentiation in an auto-augmented bladder. She underwent a radical cystectomy and a bilateral lymph node dissection. However, only 10 months after the onset of her symptoms, she died after major lymphatic metastases had developed in the small pelvis. This case report is the first on an adult spina bifida patient developing bladder carcinoma after detrusorectomy. It shows that bladder cancer also occurs in patients who underwent detrusorectomy, despite the fact that the risk is supposedly lower than in patients who underwent enterocystoplasty. Moreover, tumour spread to adjacent organs could occur more rapidly in auto-augmented bladders because of the lack of muscle tissue. The latter could have serious implications on the prognosis of these patients.

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Computed tomography–intravenous pyelography (CT–IVP) at the time of metastasis. Two lymph node metastases (77.4 and 58.2 mm) in the small pelvis are clearly visible
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Fig2: Computed tomography–intravenous pyelography (CT–IVP) at the time of metastasis. Two lymph node metastases (77.4 and 58.2 mm) in the small pelvis are clearly visible

Mentions: At histological examination, a muscle and blood vessel invasive, poorly differentiated transitional cell carcinoma with sarcomatoid differentiation was seen. The tumour measured 10 centimetres with a maximal infiltration depth of 1.8 centimetres and was removed radically. One of the para-iliac lymph nodes contained a metastasis of the bladder tumour. Eventually, the TNM tumour stadium was T3N1M0 (TNM Classification 2002), grade III (WHO 1973), with sarcomatoid differentiation. Three months later, at CT abdomen, large bilateral lymph node masses were detected, very suggestive for metastasis (Fig. 2). Also, infiltration to the sigmoid colon was seen, as infiltration to the iliac veins. She was referred to medical oncology but found to be unfit for systemic chemotherapy because of a body weight of 36 kilograms and a poor nutritional status. She was a candidate for undergoing stenting of the iliac veins, since pain and oedema developed in the lower extremities due to venous drainage obstruction in the small pelvis. However, this was eventually not done because she developed urosepsis at the day of operation. Constipation developed because of a mass effect of the metastases on the sigmoid colon. The consulting surgeon decided to treat this conservatively. She was referred to a hospice with no further therapy than adequate analgesia and comforting and died in June 2009 at the age of 32 years, about 8 months after diagnosis.Fig. 2


Bladder carcinoma in a 31-year-old female spina bifida patient with an auto-augmented bladder.

Veenboer PW, de Kort LM - Int Urol Nephrol (2011)

Computed tomography–intravenous pyelography (CT–IVP) at the time of metastasis. Two lymph node metastases (77.4 and 58.2 mm) in the small pelvis are clearly visible
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3401495&req=5

Fig2: Computed tomography–intravenous pyelography (CT–IVP) at the time of metastasis. Two lymph node metastases (77.4 and 58.2 mm) in the small pelvis are clearly visible
Mentions: At histological examination, a muscle and blood vessel invasive, poorly differentiated transitional cell carcinoma with sarcomatoid differentiation was seen. The tumour measured 10 centimetres with a maximal infiltration depth of 1.8 centimetres and was removed radically. One of the para-iliac lymph nodes contained a metastasis of the bladder tumour. Eventually, the TNM tumour stadium was T3N1M0 (TNM Classification 2002), grade III (WHO 1973), with sarcomatoid differentiation. Three months later, at CT abdomen, large bilateral lymph node masses were detected, very suggestive for metastasis (Fig. 2). Also, infiltration to the sigmoid colon was seen, as infiltration to the iliac veins. She was referred to medical oncology but found to be unfit for systemic chemotherapy because of a body weight of 36 kilograms and a poor nutritional status. She was a candidate for undergoing stenting of the iliac veins, since pain and oedema developed in the lower extremities due to venous drainage obstruction in the small pelvis. However, this was eventually not done because she developed urosepsis at the day of operation. Constipation developed because of a mass effect of the metastases on the sigmoid colon. The consulting surgeon decided to treat this conservatively. She was referred to a hospice with no further therapy than adequate analgesia and comforting and died in June 2009 at the age of 32 years, about 8 months after diagnosis.Fig. 2

Bottom Line: However, only 10 months after the onset of her symptoms, she died after major lymphatic metastases had developed in the small pelvis.This case report is the first on an adult spina bifida patient developing bladder carcinoma after detrusorectomy.The latter could have serious implications on the prognosis of these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Medical Centre Utrecht (UMC Utrecht), Heidelberglaan 100, Huispostnr. C.04.236, 3584 CX Utrecht, The Netherlands. p.w.veenboer@students.uu.nl

ABSTRACT
We present the case of a 31-year-old spina bifida patient presenting with a poorly differentiated T3N1M0 bladder carcinoma with sarcomatoid differentiation in an auto-augmented bladder. She underwent a radical cystectomy and a bilateral lymph node dissection. However, only 10 months after the onset of her symptoms, she died after major lymphatic metastases had developed in the small pelvis. This case report is the first on an adult spina bifida patient developing bladder carcinoma after detrusorectomy. It shows that bladder cancer also occurs in patients who underwent detrusorectomy, despite the fact that the risk is supposedly lower than in patients who underwent enterocystoplasty. Moreover, tumour spread to adjacent organs could occur more rapidly in auto-augmented bladders because of the lack of muscle tissue. The latter could have serious implications on the prognosis of these patients.

Show MeSH
Related in: MedlinePlus