CARCINOMA
OF BLADDER
METASTATIC
TO BREAST
BRUCE
H. TRUESDALE,
R. DUREN
JOHNSON,
STARLING
C. EVINS,
M.D. M.D. M.D.
From the Departments of Urology and Pathology, Medical University of South Carolina, Charleston, South Carolina
ABSTRACT Reported herein is the first case, to our knowledge, of carcinoma of the bladder metastatic to the breast. A review of the English literature and about 300,000 surgical reports and 10,000 autopsy reports, including all patients with carcinoma of the bladder at the Medical University of South Carolina, failed to reveal any such cases.
Carcinoma of the bladder most commonly metastasizes to the lymph nodes, lungs, liver, and b0ne.l Metastasis has been reported to skin, prostate, spleen, intestine, pancreas, and heart.’ Reported here is the first case of carcinoma of the bladder metastatic to the male breast. Case Report A sixty-nine-year-old black man with a history of transitional cell carcinoma of the bladder treated by transurethral resection in 1971 was found in 1975 to have a recurrent lesion in the posterior left bladder wall. He underwent a transurethral resection of the tumor revealing a grade III, Stage B2 transitional cell carcinoma. An ileal conduit for urinary diversion was constructed followed by interval irradiation therapy consisting of 4,500 rads and a radical cystoprostatectomy six weeks after completion of the irradiation therapy. Approximately eighteen months after cystectomy, a 2 by 3-cm. mass was noted in the suprasternal area and a biopsy revealed transitional cell carcinoma. Twentyseven months postcystectomy, a 3-cm. mass was noted in the medial portion of the left breast and an excisional biopsy revealed poorly differentiated transitional cell carcinoma metastatic to the breast.
430
Pathology Microscopic examination of the recurrent bladder tumor revealed a grade III transitional cell carcinoma, composed of strands of neoplastic cells with hyperchromatic nuclei and a stippled chromatin pattern (Fig. 1A). Focal areas of squamous metaplasia were present. Portions of superficial and deep muscularis revealed neoplastic invasion. The cystectomy specimen consisted of an 8 x 7 x 4 cm. bladder with a 4 x 4 cm. area of ulceration extending outward from the trigone (Fig 1B). Microscopic examination revealed extensive superficial ulceration and loss of the surface mucosa in the area of the trigone with underlying grade III transitional cell carcinoma. There was extension of the tumor into the upper one third of the muscularis, and perineural invasion was present. Lymphatic involvement was noted. Sections of margins, both ureters, and vas deferens were free of tumor. No significant radiation changes were noted. Histologically the tumor cells were identical in appearance to those seen in the first biopsy. The breast lesion consisted of a multilobulated portion of gray and yellow tissue with surrounding adipose tissue and measured 2.8 by 2.3 by 1.5 cm. (Fig. 1C). The microscopic examination revealed clusters and strands of
UROLOGY
/ APRIL 1979 / VOLUME
XIII.
NUMBER 4
FIGURE 1. (A) First bladder biopsy: tumor is composed of strands of neoplastic cells with hyperchromatic nuclei and pale cytoplasm (transitional cell carcinoma, grade III). (B) Cystectomy specimen showing extensive involvement of submucosa by grade ZZZtransitional cell carcinoma. (C) Breast mass showing marked desmoplastic reaction in which can be seen islands and strands of neoplastic cells identical in appearance to those seen in A and B (metastatic, transitional cell carcinoma, grade ZZZ to breast). (Hematoxylin and eosin, original magnification x 80, x 200, and x 200, respectively.)
hyperchromatic neoplastic cells identical in appearance to those seen in the first two specimens. A marked desmoplastic reaction was also present. In an extensive review of seven autopsy series and in their own series of patients with carcinoma of the bladder, Fetter et ~1.~ collected 307 autopsy cases with none reporting metastatic lesions in the breast. Cooling3 reviewed an additional 150 autopsy reports on patients with carcinoma of the bladder, and there were no metastatic lesions in the breast. A review of the English literature and a review of about 300,000 surgical reports and 10,000 autopsy reports at the Medical University of South Carolina including all patients with carcinoma of the blad-
UROLOGY
/
APRIL
1979
/
VOLUME
XIII.
NUMBER
4
der failed to reveal another case of carcinoma the bladder metastatic to the breasts.
of
Department of Urology 171 Ashley Avenue Charleston, South Carolina 29403 (DR. EVINS) References 1. Koss LG: Tumors of the urinary bladder, in: Atlas of Tumor Pathology, Armed Forces Institute of Pathology, Washington, D.C., 1975, p. 61. 2. Fetter TR, Bogaev JH, McCuskey B, and Seres JL: Carcinoma of the bladder: sites of metastases, J. Urol. 81: 746 (1959). 3. Cooling CE: Review of 159 postmortems of carcinoma of the urinary bladder, in Wallace DM, Ed: Tumors of the Bladder. Neoplastic Disease at Various Sites, Baltimore, The Williams and Wilkins Co., 1959, vol. 2, pp. 171-166.
431
OF BLADDER
METASTATIC
TO BREAST
BRUCE
H. TRUESDALE,
R. DUREN
JOHNSON,
STARLING
C. EVINS,
M.D. M.D. M.D.
From the Departments of Urology and Pathology, Medical University of South Carolina, Charleston, South Carolina
ABSTRACT Reported herein is the first case, to our knowledge, of carcinoma of the bladder metastatic to the breast. A review of the English literature and about 300,000 surgical reports and 10,000 autopsy reports, including all patients with carcinoma of the bladder at the Medical University of South Carolina, failed to reveal any such cases.
Carcinoma of the bladder most commonly metastasizes to the lymph nodes, lungs, liver, and b0ne.l Metastasis has been reported to skin, prostate, spleen, intestine, pancreas, and heart.’ Reported here is the first case of carcinoma of the bladder metastatic to the male breast. Case Report A sixty-nine-year-old black man with a history of transitional cell carcinoma of the bladder treated by transurethral resection in 1971 was found in 1975 to have a recurrent lesion in the posterior left bladder wall. He underwent a transurethral resection of the tumor revealing a grade III, Stage B2 transitional cell carcinoma. An ileal conduit for urinary diversion was constructed followed by interval irradiation therapy consisting of 4,500 rads and a radical cystoprostatectomy six weeks after completion of the irradiation therapy. Approximately eighteen months after cystectomy, a 2 by 3-cm. mass was noted in the suprasternal area and a biopsy revealed transitional cell carcinoma. Twentyseven months postcystectomy, a 3-cm. mass was noted in the medial portion of the left breast and an excisional biopsy revealed poorly differentiated transitional cell carcinoma metastatic to the breast.
430
Pathology Microscopic examination of the recurrent bladder tumor revealed a grade III transitional cell carcinoma, composed of strands of neoplastic cells with hyperchromatic nuclei and a stippled chromatin pattern (Fig. 1A). Focal areas of squamous metaplasia were present. Portions of superficial and deep muscularis revealed neoplastic invasion. The cystectomy specimen consisted of an 8 x 7 x 4 cm. bladder with a 4 x 4 cm. area of ulceration extending outward from the trigone (Fig 1B). Microscopic examination revealed extensive superficial ulceration and loss of the surface mucosa in the area of the trigone with underlying grade III transitional cell carcinoma. There was extension of the tumor into the upper one third of the muscularis, and perineural invasion was present. Lymphatic involvement was noted. Sections of margins, both ureters, and vas deferens were free of tumor. No significant radiation changes were noted. Histologically the tumor cells were identical in appearance to those seen in the first biopsy. The breast lesion consisted of a multilobulated portion of gray and yellow tissue with surrounding adipose tissue and measured 2.8 by 2.3 by 1.5 cm. (Fig. 1C). The microscopic examination revealed clusters and strands of
UROLOGY
/ APRIL 1979 / VOLUME
XIII.
NUMBER 4
FIGURE 1. (A) First bladder biopsy: tumor is composed of strands of neoplastic cells with hyperchromatic nuclei and pale cytoplasm (transitional cell carcinoma, grade III). (B) Cystectomy specimen showing extensive involvement of submucosa by grade ZZZtransitional cell carcinoma. (C) Breast mass showing marked desmoplastic reaction in which can be seen islands and strands of neoplastic cells identical in appearance to those seen in A and B (metastatic, transitional cell carcinoma, grade ZZZ to breast). (Hematoxylin and eosin, original magnification x 80, x 200, and x 200, respectively.)
hyperchromatic neoplastic cells identical in appearance to those seen in the first two specimens. A marked desmoplastic reaction was also present. In an extensive review of seven autopsy series and in their own series of patients with carcinoma of the bladder, Fetter et ~1.~ collected 307 autopsy cases with none reporting metastatic lesions in the breast. Cooling3 reviewed an additional 150 autopsy reports on patients with carcinoma of the bladder, and there were no metastatic lesions in the breast. A review of the English literature and a review of about 300,000 surgical reports and 10,000 autopsy reports at the Medical University of South Carolina including all patients with carcinoma of the blad-
UROLOGY
/
APRIL
1979
/
VOLUME
XIII.
NUMBER
4
der failed to reveal another case of carcinoma the bladder metastatic to the breasts.
of
Department of Urology 171 Ashley Avenue Charleston, South Carolina 29403 (DR. EVINS) References 1. Koss LG: Tumors of the urinary bladder, in: Atlas of Tumor Pathology, Armed Forces Institute of Pathology, Washington, D.C., 1975, p. 61. 2. Fetter TR, Bogaev JH, McCuskey B, and Seres JL: Carcinoma of the bladder: sites of metastases, J. Urol. 81: 746 (1959). 3. Cooling CE: Review of 159 postmortems of carcinoma of the urinary bladder, in Wallace DM, Ed: Tumors of the Bladder. Neoplastic Disease at Various Sites, Baltimore, The Williams and Wilkins Co., 1959, vol. 2, pp. 171-166.
431
