Two cases of osteoblastic bone metastasis from muscle-invasive bladder cancer with discrepancy in response to chemotherapy: problems and limitations of bone biopsy

Abstract

We report two cases of muscle-invasive bladder cancer (MIBC) with increasing multiple osteoblastic bone lesions but shrinking other lesions in response to chemotherapy. Case 1 had MIBC and received radical cystectomy followed by adjuvant gemcitabine plus cisplatin chemotherapy (GC). Three years after, follow computed tomography (CT) showed development of multiple lymph node metastasis, and then we performed GC as a first-line systemic chemotherapy. After two cycles of GC, CT showed de novo multiple osteoblastic lesions although metastatic lymph nodes were shrunk. Biopsy of the sternum revealed metastatic urothelial carcinoma. Case 2 had MIBC with multiple osteoblastic lesions on CT and bone scintigraphy, which was initially diagnosed as cT3bN0M1. After one cycle of GC, the number of osteoblastic lesions obviously increased although bladder tumor was regressed. Since the clinical course was unusual, biopsy of the clavicle was done. The histological diagnosis was benign osteoblastic bone disease, then the clinical diagnosis was revised to non-metastatic MIBC, and radical cystectomy was performed. Ten months after surgery, the patients complained worsening backache and CT showed increase in number of osteoblastic lesions. Eventually, ilium biopsy revealed bone metastasis of urothelial carcinoma. In case of atypical finding and unusual clinical course, biopsy of suspected metastatic lesion may be informative although adequate sampling should be secured.

Sternum Metastases: From Case-Identifying Strategy to Multidisciplinary Management

“…The same procedure, an open bone (sternum) biopsy was performed on 68-year-old male diagnosed with bladder cancer and osteoblastic lesions with discordant evolution under chemotherapy when compared to the primary site. In cases with multiple skeletal involvements, the decision of performing a biopsy is multidisciplinary, to a certain extent, and it primarily takes into account imaging assessments, such as CT and whole-body bone scintigram, as seen here [ 99 ].…”

“…Overall, we identified 14 studies (of more than 1 subject/article) [ 18 , 20 , 21 , 22 , 24 , 51 , 53 , 64 , 66 , 70 , 72 , 73 , 74 , 75 ] and 34 single case reports [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ] within our methods with respect to sternal metastases (n = 48 papers) ( Table 5 ).…”

“… Overview of published case reports (N = 34) according to our methods [ 14 , 15 , 16 , 17 , 19 , 23 , 25 , 26 , 30 , 32 , 33 , 37 , 38 , 41 , 42 , 43 , 47 , 52 , 55 , 56 , 59 , 60 , 62 , 68 , 71 , 76 , 77 , 78 , 89 , 98 , 99 , 100 , 101 , 102 ]. Abbreviations: N = number of patients; MiNEN = mixed neuroendocrine–non-neuroendocrine tumour.…”

Urothelial Carcinoma With Bone Metastasis Mimicking Sciatica: A Common Neoplasm With an Uncommon Presentation

“…UC metastasis has a male predominance (60%) with a median age of 66.5 years in the patients [2]. Typical bone metastasis is osteolytic (70%), but UC can also cause osteoblastic lesions (10%), although rare [3]. The usual initial symptom is hematuria and flank pain in one-third of patients [4].…”

Prognostic analysis of percutaneous vertebroplasty (PVP) combined with 125I implantation on lumbosacral vertebral osteoblastic metastases

“…Spinal metastases, including osteolytic, osteoblastic, and mixed bone metastases, are common complications of malignant cancers [1,2]. Osteoblastic metastases occur most commonly in patients with prostate [3][4][5][6], gastric [7,8], bladder [9,10], lung [11,12], and breast cancer [13][14][15]. The incidence of metastatic spinal tumors has gradually increased recently with the increasing prevalence of various tumors worldwide [16].…”