Urothelial carcinoma of the bladder with asynchronous metastases to both testes
A 71-year-old male presented with clot retention, with a large bladder mass consistent with UC identified by cystoscopy and subsequently fully resected via transurethral resection of bladder tumor (TURBT). Histology confirmed invasive (G3T2) UC with squamous differentiation. CT staging at the time [] revealed a right upper lobe pulmonary nodule of 15 × 15 mm, and a fine needle aspirate confirmed malignant cells. A fluorodeoxyglucose (FDG) study demonstrated uptake only within the pulmonary lesion.\nTreatment was initiated using 66 Gy radiotherapy plus gemcitabine-based chemotherapy. A reduction in the size of the lung metastasis was noted on subsequent FDG PET (PET: Positron emission tomography) scanning.\nApproximately one year after his initial presentation, the patient noted painless swelling of his left testicle. Ultrasound [] confirmed a mixed solid cystic lesion, which was treated by a left inguinal orchidectomy. Histology revealed metastatic UC. At that time, the right testis was normal; however, nine months later, he re-presented with a similar painless swelling in the other testicle and later went on to have a right inguinal orchidectomy. Serum tumor markers at both presentations were negative. Histology again confirmed metastatic UC, with squamous differentiation. The patient thereafter received three-monthly testosterone replacement. On repeat staging computerized tomography (CT), mediastinal lymphadenopathy was noted, but there was no other evidence of metastasis [].\nSubsequently, four-month surveillance CT revealed that the patient's disease had progressed with metastatic disease developing in pulmonary and paratracheal tissue. Ultrasound-guided biopsy confirmed urothelial origin. Despite further systemic chemotherapy, the patient died approximately two years after his initial presentation.