Page 142 - Read Online

ureteric orifice and the lesion was primarily situated within single metastasis exists in the bladder. [7,9] To summarise,
the urothelium. it must be emphasized that not all papillary tumors
of the bladder are primary transitional cell carcinomas.
The most common presenting symptom of bladder Metastasis from papillary RCC must also be considered
metastasis is hematuria. In a patient with synchronous in a patient with a history of renal malignancy presenting
bladder metastasis, hematuria may be wrongly attributed with hematuria or a bladder mass. As in our case, these
to collecting system infiltration of RCC. The bladder metastases may present several years after treatment of
metastasis may, thus be overlooked, only to become the primary malignancy.
apparent later, when the patient continues to have
hematuria post-nephrectomy. This has led some authors Financial support and sponsorship
to recommend cystoscopic evaluation in all patients with Nil.
RCC and hematuria. [4,6]
Conflicts of interest
The definitive diagnosis of bladder metastasis is made by There are no conflicts of interest.
cystoscopy and biopsy or transurethral resection. The
metastasis histologically resembles their renal primary. REFERENCES
However, a basic immunohistochemical panel is useful to
differentiate metastasis from poorly differentiated bladder 1. Campbell SC, Lane BR. Malignant renal tumors. In: Wein AJ, editor.
tumors. RCC metastasis, like their primaries, show positive Campbell-Walsh Urology. 10th ed. Philadelphia: Saunders; 2011. p.
staining for CK AE1/AE3, CK7, CD10 and vimentin. 1433-4.
[4]
Well-differentiated primary papillary urothelial carcinomas 2. Zhang M, Wah C, Epstein JI. Metastatic renal cell carcinoma
are positive for CK7 and usually negative for vimentin. to the urinary bladder: a report of 11 cases. Am J Surg Pathol
2014;38:1516-21.
Urothelial carcinomas attain vimentin positivity only on 3. Gelister JS, Falzon M, Crawford R, Chapple CR, Hendry WF. Urinary
sarcomatoid transformation. In diagnostically challenging tract metastasis from renal carcinoma. Br J Urol 1992;69:250-2.
cases, discriminatory immunohistochemical markers, such 4. Masayo K, Kyoko I, Kyoko H, Tohru T. Bladder metastasis of
as PAX8 and GATA3 positivity, may be used to differentiate renal cell carcinoma: a case study. Acta Urol Jpn 2007;53:571-4.
metastatic RCC from primary bladder urothelial carcinoma, 5. Doo SW, Kim WB, Kim BK, Yang WJ, Yoon JH, Jin SY, Yun
in addition to alpha-methylacyl coenzyme A racemase SS. Metastasis of renal cell carcinoma to the bladder. Korean J Urol
2013;54:69-72.
positivity for papillary RCC. [2] 6. Swanson DA, Liles A. Bladder metastasis: a rare cause of hematuria
in renal cell carcinoma. J Surg Oncol 1982;20:80-2.
Due to the rare occurrence of bladder metastasis, there 7. Russo P, O’Brien MF. Surgical intervention in patients with
are no established recommendations for management. metastatic renal cancer: metastasectomy and cytoreductive
Metastasectomy has been advocated if complete resection nephrectomy. Urol Clin North Am 2002;35:679-86.
of all metastasis can be accomplished. Management 8. Matsuo M, Koga S, Nishikido M, Noguchi M, Sakaguchi M,
[7]
options that have been described, include partial cystectomy Nomata K, Maruta N, Hayashi T, Kanetake H. Renal cell carcinoma
with solitary metachronous metastasis to the urinary bladder. Urology
or transurethral resection, either as a single modality or in 2002;60:911-2.
combination with immunotherapy or targeted therapy. [8] 9. Raviv S, Eggener SE, Williams DH, Garnett JE, Pins MR,
Smith ND. Long-term survival after “drop metastases” of renal cell
Prognosis has been reported to be good only when a carcinoma to the bladder. Urology 2002;60:697.

132
Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ March 28, 2016 ¦