Metastatic transitional cell carcinoma of the bladder in an ileal conduit stoma. A case report and literature review

Abstract

Clinical case presentation: An 80-year-old man was admitted to our emergency department due to fever and progressively growing mass in the urinary diversion stoma four months after a radical cystectomy for muscle invasive bladder cancer.
 Surgical resection was done, and histo-pathological examination revealed metastases of high-grade urothelial carcinoma. After almost three years of follow-up any sign of recurrence did not seen. 
 Relevance: Urothelial cancer at all stages can metastasize to other organs.
 Metastasis occurs hematogenously to all organs, most frequently the lungs, liver, bone, or lymphatically to regional lymph nodes in the pelvis, or further to retroperitoneal lymph nodes. Metastasis of bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has-been reported in ureteroileal anastomosis.
 Clinical implications: Surgical treatment is an option in these patients. Adjuvant radiotherapy and / or chemotherapy would be possible alternatives in more than one site of metastasis. There are no clinical guidelines establishing their correct management.
 Conclusion: The urinary diversion stoma metastases secondary to a urothelial carcinoma is a rare entity. Direct implantation during the surgical act, hematogenous, lymphatic or mixed dissemination, could justify metastatic implantation.