Metastatic lung adenocarcinoma to the bladder: A case report

Abstract

Abstract. Urothelial cancer is the most frequently diagnosed type of malignant tumor in the bladder, of which primary adenocarcinoma accounts for a small percentage. Secondary malignancies, in particular metastatic adenocarcinoma from the lung, are exceedingly rare, with only six cases previously reported in the literature. The present study describes the case of a 71-year-old Chinese male patient with known lung cancer for >2 years, who was diagnosed with metastatic adenocarcinoma to the bladder. The histopathological characteristics and immunohistochemical features of the patient are reported. It was proposed that pathologists should consider the possibility of metastatic adenocarcinoma from the lung, rather than assume a diagnosis of primary adenocarcinoma of the bladder or direct invasion of adenocarcinoma from the surrounding organs. Furthermore, it is essential to determine the medical history of each patient and observe the immunohistochemical features of all tumors prior to diagnosis. IntroductionBladder cancer is the fifth most common type of malignant tumor. Among bladder malignancies, urothelial carcinomas are the most frequent histological type, of which adenocarcinoma, squamous cell cancer and small-cell cancer account for small percentages (1,2). Primary adenocarcinomas were reported to account for 0.5-2% of primary bladder epithelial malignancies; these malignancies most commonly arise in the urachus (3).In addition, secondary adenocarcinomas may also occur as a result of direct invasion from the surrounding organs, including prostate, colorectal and cervical sites (3). Furthermore, metastatic spread may occur via lymphogenous or hematogenous routes (4). However, the bladder is not a favored site for tumor metastases; in particular, adenocarcinoma from the lung is exceptionally rare (5). The present study describes a case of metastatic adenocarcinoma from the lung to the bladder and reports the histopathological characteristics and immunohistochemical features of the patient. The aim of the present study was to emphasize the importance of considering of metastatic adenocarcinoma from the lung as a possible diagnosis, in addition to primary adenocarcinoma and direct invasion of adenocarcinoma from the immediate surrounding organs. Case reportA 71-year-old Chinese male with known lung cancer for >2 years was referred to the People's Liberation Army 205 Hospital (Jinzhou, China) due to a gross hematuria, which had persisted for 5 days. This initial diagnosis of lung adenocarcinoma occurred >2 years previously, when the patient was admitted to a local hospital due to a cough and expectoration. Following the initial admission to hospital, a thoracic computed tomography (CT) revealed a 3x2x2 cm mass in the lower lobe of the patient's left lung; consequently, a needle biopsy was performed and the patient was diagnosed with adenocarcinoma of the lung (histological sections were not available for review). The patient elected not to undergo any therapy, including surgical resection, chemical therapy or radi...

Lung adenocarcinoma with bladder metastasis: A case report and literature review

“…TTF-1 is a sensitive marker for primary lung adenocarcinoma, but its specificity is significantly lower than that of Napsin A. There are no reports of primary bladder adenocarcinoma expressing TTF-1 ( 16 ). However, of the 15 reported cases of bladder metastasis from lung adenocarcinoma, TTF-1 was found to be negative in 2 of the bladder metastases but positive in 1 of the primary tumors.…”

Bladder Metastases from Lung Cancer: Clinical and Pathological Implications: A Systematic Review

“…In the literature, gross hematuria is the major presenting symptom (5/11 cases, 45%) [8,22,26,29,30,31]. In such cases, hematuria occurs as a result of deep-seated neoplastic cells infiltrating and ulcerating the bladder lining [21]; therefore, gross hematuria is a BM late event accounting for a delayed diagnosis.…”

“…Previous large autopsy series describe BMs as late complications of primary disease, typically developing in an advanced setting with widespread metastases [11], while in the recent reported cases, secondary involvement of the bladder by LC cells occurs within months after the first diagnosis of LC (range 1-24 months; mean 12), and the bladder is often the only metastatic site (7/11; 64%) [23,24,25,26,27,28,29]. …”

“…A thorough revision of the reported cases [21,22,23,24,25,26,27,28,29,30,31] (Table 1) failed to disclose any association between the LC clinical status (dimension, side, location, number of lesions, positive mediastinal nodes) and the occurrence of BMs, mostly due to the high heterogeneity of the available information (for instance, the mediastinal node status was fully reported only by 2 authors out of 11), and to the small number of cases examined. For the same reason, we were not able to indicate which conditioning factors among the clinical characteristics of LC patients may favor the development of a BM (i.e., smoking status, immunological deficiency, previous chemotherapy treatments, previous tumor different than LC, kind of comorbidities).…”