Hemorrhagic brain metastasis from small-cell carcinoma of the urinary bladder

Abstract

Background: Small-cell carcinoma of the urinary bladder (SCCB) accounts for 1% of all bladder tumors. We present a rare case of hemorrhagic metastatic brain tumor from SCCB diagnosed by navigation-guided endoscopic biopsy. Case Description: A 76-year-old man presented with sudden onset of aphasia and right hemiplegia from 3 weeks previously. He had a medical history of prostate cancer and SCCB. Computed tomography showed a mixed density mass in the left basal ganglia. On magnetic resonance imaging, the mass showed mixed intensity in both T1-weighted images and T2-weighted images, suggesting subacute hemorrhage. The mass was partially enhanced with gadolinium. The patient underwent endoscopic hematoma evacuation and partial removal of the tumor. Histopathological diagnosis was neuroendocrine carcinoma, which was consistent with SCCB metastasis. After surgery, the patient underwent whole-brain radiation therapy of 30 Gy. His general condition gradually deteriorated, however, and he died 4 months after surgery. Conclusion: Our patient had a rare case of brain metastasis derived from SCCB which presented with cerebral hemorrhage. Navigation-guided endoscopic biopsy was useful for the diagnostic sampling of deep localized brain tumors with hemorrhage.

Surgical Treatment for Metastatic Brain Tumor in the Cerebellar Hemisphere from Small-cell Neuroendocrine Carcinoma of the Urinary Bladder: A Case Report and Review of the Literature

“…To the best of our knowledge, only two previous reports have focused on the surgical treatment of SCNC of the urinary bladder for metastatic brain tumors thus far. 1 , 2 ) Isaka et al reported a case involving surgery performed for a metastatic lesion in the left frontal lobe, including radiological, intraoperative, and pathological findings. 1 ) In that case, intense tumor staining was noted from early in the arterial phase on angiography, and there was substantial intraoperative bleeding from the fine vessels consistent with this finding.…”

“…Maeshima et al presented a case of metastatic tumor of the basal ganglia that resulted in intratumoral hemorrhaging and required hematoma evacuation. 2 ) Moreover, Theodros et al reported that primary small intestine tumors as extrapulmonary SCNC were highly vascularized and associated with substantial difficulty achieving hemostasis. 3 ) It has been reported that metastatic brain tumors derived from lung cancer are prone to bleeding, 7 ) and metastasis from SCNC of the bladder may have similar clinical features to small-cell lung cancer brain metastases.…”

“…This atypical finding for a metastatic brain tu-mor was similar to the image findings in the cases reported by Isaka and Maeshima. 1,2) One possible explanation for this is that it has been proposed that high apparent diffusion coefficient (ADC) values in brain metastases may result in larger peritumoral edema volumes due to increased water influx into the tumor interstitium, 9) while tumors with low ADC values, as in this case, may not necessarily result in as significant peritumoral edema since ADC is an index of the magnitude of water molecule diffusion within the tumor. Although the accumulation of further cases is needed, this may be a potentially distinctive radiological finding in brain metastases of SCNC of the bladder.…”

“…Of note, only a few reports have described surgical treatment for metastatic brain tumors due to extrapulmonary SCNC. [1][2][3] All three case reports stated that it is highly vascular-rich and hemorrhagic, has strong invasiveness to the brain parenchyma, and has an unclear border with the brain.…”