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Case Report

Metachronous bladder metastasis from papillary renal cell carcinoma

Arun Ramdas Menon , Nivedita Suresh , Prajwal Ravinder , Rajeev Thekke Puthalath 1
1
1
2
1 Department of Urology, K S Hegde Medical Academy, Mangalore 575018, Karnataka, India.
2 Department of Pathology, K S Hegde Medical Academy, Mangalore 575018, Karnataka, India.
Correspondence to: Dr. Arun Ramdas Menon, Department of Urology, Justice K. S. Hegde Medical College Hospital, Mangalore 575018,
Karnataka, India. E-mail: dr_arunrmenon@yahoo.com

A B S T R AC T
Renal cell carcinoma (RCC) is well known for its metastatic potential and predilection for unusual sites of metastasis. Metastasis
to the bladder is rare and has been reported predominantly from clear cell RCC. We report a case of a 72-year-old male presenting
with a bladder tumor which on histopathological evaluation was found to be a metastasis from papillary RCC, 7 years after radical
nephrectomy. This case highlights the need to maintain a high index of suspicion to diagnose bladder metastasis in a patient with
a history of RCC presenting with a bladder lesion.

Key words: Bladder metastasis; metachronous metastasis; renal cell carcinoma

INTRODUCTION local tumor recurrence or intra-abdominal metastasis.
However, a chest radiograph revealed multiple cannon ball
Renal cell carcinoma (RCC) metastasizing to the bladder is metastases. Cystoscopic examination revealed a solitary,
a rare phenomenon. It can be easily mistaken for primary broad-based lesion in the region of the left ureteric orifice
bladder tumor on cystoscopy. Of the few cases reported [Figure 2]. The rest of the bladder was unremarkable.
in literature, bladder metastasis was predominantly from A cold cup biopsy of the lesion showed a neoplasm
clear cell RCC. Here, we report a case of bladder arranged predominantly in papillary pattern and focal
metastasis from papillary RCC presenting 7 years after areas of solid sheets, both composed of tumor cells with
radical nephrectomy. moderate eosinophilic cytoplasm and low-grade nuclear
features. Immunohistochemistry revealed strong diffuse
CASE REPORT positivity for cytokeratin 7 (CK7), vimentin and focal
positivity for cluster of differentiation 10 (CD10) [Figure
A 72-year-old male, a chronic smoker, presented with 3], suggesting a metastatic bladder tumor from renal
irritative lower urinary tract symptoms. He had undergone papillary adenocarcinoma.
left radical nephrectomy for RCC (papillary sub-type,
stage T3N0M0) 7 years ago. Clinical examination was The patient was counseled regarding his disease; he refused
unremarkable. His baseline investigations, including active therapy and was referred for palliative care. He died
complete blood counts and serum biochemistry, were of progressive disease 10 months later.
within normal limits. Urine analysis showed microscopic
hematuria. A transabdominal sonography revealed a 3 DISCUSSION
cm hyperechoic lesion in the left postero-lateral wall
of the bladder. Abdominal contrast-enhanced computed RCC can be an aggressive disease with the ability to
tomography (CECT) confirmed the same lesion [Figure 1]. metastasize widely. Besides the common sites of metastasis,
No extra-vesical spread or pelvic lymph node metastasis i.e. lung, liver, bone and brain, RCC can also metastasize
was evident. The CECT also confirmed that he was
post-left radical nephrectomy; there was no evidence of This is an open access article distributed under the terms of the Creative
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How to cite this article: Menon AR, Suresh N, Ravinder P, Puthalath
RT. Metachronous bladder metastasis from papillary renal cell
DOI: carcinoma. J Cancer Metastasis Treat 2016;2:130-2.
10.4103/2394-4722.169645
Received: 07-07-2015; Accepted: 21-10-2015.

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