Brain and Skin Metastasis From Urothelial Carcinoma of the Bladder
A 60-year-old man presented to the emergency room with severe dyspnea that had developed 20 hours earlier. He had undergone a radical cystectomy with an ileal conduit 10 years previously. Postoperative pathological results revealed urothelial carcinoma of stage T1N0M0 (). After discharge, the patient had failed to attend routine follow-up visits for 8 years. After 8 years, he presented to the outpatient clinic with complaints of urethral bleeding. A urethroscopic biopsy revealed recurred urothelial carcinoma. After a radiologic work-up, he received three cycles of systemic combination chemotherapy with gemcitabine and cisplatin for urothelial carcinoma metastasized to the lungs, both inguinal lymph nodes, and both iliac chain lymph nodes. However, the lymphadenopathy was so aggravated that the response to systemic chemotherapy seemed to be ineffective. One year later, computed tomography (CT) was performed to evaluate dizziness. Brain CT revealed a 3×4 cm sized mass in the left cerebellar hemisphere (). A metastasectomy was performed and the mass proved to be metastatic urothelial carcinoma ().\nThe patient was admitted for palliative treatment. Physical examination revealed multiple, 1-cm, erythematic nodular abdominal skin lesions (). Other findings from the physical examination were unremarkable. Laboratory findings were inconclusive. He underwent excisional biopsy of the skin lesions and the final histopathologic report was consistent with metastatic urothelial carcinoma (). He died from acute respiratory distress syndrome the day after the excisional biopsy.