Disseminated Intravascular Coagulation with Enhanced Fibrinolysis Caused by Heart Metastasis of Bladder Urothelial Carcinoma

Abstract

Heart metastases from urothelial carcinoma of the bladder have rarely been reported in the literature. We present a case complicated by symptomatic disseminated intravascular coagulation in a 67-year-old woman. A rapid and sustained recovery from hemostatic troubles was obtained following fibrinogen supplementation combined with second-line paclitaxel chemotherapy.

Urothelial bladder cancer with cardiac metastasis: Literature review and case report

“…The analysis of 20 studies, plus our case report totaled 30 patients described between 1934 and 2023, proving the rarity of cardiac metastasis of TCC [ 2 , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Data in showed that patients with cardiac metastasis from TCC are predominantly men (77.78 %), mean age 65.47 years, most patients were diagnosed after death by autopsy (57.90 %) ( Table 1 and Fig.…”

“…Caucasian ethnicity, and comorbidities such as exposure to smoking and arterial hypertension were more prevalent. Only 10 studies [ 2 , [9] , [10] , [11] , [12] , [14] , [15] , [16] , 18 , 23 ] report the TNM staging profile of TCC bladder cancer, with tumors T1 (20.00 %), T2 (10.00 %), T3 (50.00 %), T4 (20.00 %), WHO classification in grade 2 (12.50 %), grade 3 (75.00 %), grade 4 (12.50 %). The size of the primary bladder mass ranged from 2.0 cm to 7.3 cm and a mean of 4.32 cm.…”

“…Most diagnoses occurred with the aid of cystoscopy and transurethral resection. 18 studies [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]reported some type of treatment administered after a diagnosis of TCC, most patients were treated with radical cystectomy (50.00 %), chemotherapy (neoadjuvant or adjuvant) (44.45 %), and bladder reconstruction or urinary diversion (33.34 %) ( Table 1 ).

Fig.

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“…The evaluation of the 16 studies [ 2 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , 21 , 23 ] that reported the site of cardiac metastasis and other concomitant organs showed that the right ventricle (68.75 %) was the most affected, and with right atrium involvement and regional or distant lymph node enlargement (31.25 %) also being prevalente ( Table 2 ).…”

“…The most used exams for the diagnosis of cardiac metastasis were transthoracic echocardiogram (53.34 %), computed tomography (46.67 %), chest X-ray (23.34 %), electrocardiogram (16.67 %), and the diameter of the metastasis ranged from 1.3 to 7.0 cm, mean 5.20 cm. Twelve papers [ 8 , 9 , [14] , [15] , [16] , [18] , [19] , [20] , [21] , [22] , [23] ] reported pericardial effusion, and 6 papers [ 8 , 9 , 15 , [20] , [21] , [22] ] reported cardiac tamponade, and 8 papers [ 8 , 9 , [14] , [15] , [16] , [20] , [21] , [22] ] described diagnostic pericardiocentesis. The drained volume ranged from 700 to 2000 ml, mean of 1040 ml; 6 studies [ 8 , 9 , 14 , [20] , [21] , [22] ] had information on positive oncotic cytology, and of the 6 cardiac biopsies [ 10 , 11 , [14] , [15] , [16] ] reported, 4 biopsies [ 11 , [14] , [15] , [16] ] (83.34 %) were confirmed as cardiac metastasis.…”