Transitional cell carcinoma with glandular differentiation metastatic to the inguinal lymph node from the urinary bladder
A 58-year-old male patient was admitted to our clinic with complaints of hematuria and right flank pain. Contrast-enhanced computed tomography (CT) revealed diffuse bladder wall thickening and grade 2 hydroureteronephrosis in the right kidney. Transurethral resection of the bladder tumor was reported as a high-grade (G3), muscle-invasive TCC (pT2) transitional cell carcinoma. No metastasis was detected on CT and magnetic resonance imaging (MRI). The patient underwent radical cystoprostatectomy with a Studer ileal bladder substitute for orthotopic diversion with bilateral extended pelvic lymph node dissection. Histopathology confirmed muscle-invasive TCC (pT2) []. Surgical margins were free and lymph node metastasis was not detected. No complications occurred and the right kidney hydroureteronephrosis decreased.\nSix months after cystoprostatectomy, the patient was admitted with complaints of pain in the left inguinal region. Ultrasonography (USG) showed a left inguinal mass 38 cm × 25 cm × 26 mm in diameter. In addition, pelvic MRI showed a mass 1.5 cm in diameter in the left inguinal region. Positron emission tomography (PET) showed increased fluorodeoxyglucose (FDG) uptake in the left inguinal area and the maximum standardized uptake value was 9 (SUV max: 9). Left inguinal lymph node excision was planned but curative resection could not be performed because of dense adhesions to the adjacent vital structures, including the left femoral vein. Excisional biopsy was taken from the left inguinal region which was reported as adenocarcinoma, including transitional cell variants []. The patient underwent gastrointestinal evaluation to search for the primary lesion of adenocarcinoma; however, no primary site could be identified. Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 were within the normal range. Tumor cells were positive for Cytokeratin CK7 [] and negative for CK20. Based on these immunohistochemical findings, it is unlikely that the tumor had originated in the gastrointestinal tract. After four courses of chemotherapy with a combination of cisplatinum, mitomycin-c, etoposide and tegafur-/uracil,[] the metastatic tumor remained unchanged. Radiotherapy was also performed, but achieved minimal remission.