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Bladder Carcinoma Presenting as a Solitary Bony Metastasis
0022-534 7/83/1304-0973$02.00/0 Vol. 130, November Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1983 by The Williams & Wilkins Co.
BLADDER CARCINOMA PRESENTING AS A SOLITARY BONY METASTASIS T. I. MUGHAL,* R. H. PHILLIPS AND W. A. ROBINSON ;
From the Sir Stanford Cade Oncology Unit, Westminister Hospital Medical School, London, England
ABSTRACT
Although bony involvement by transitional cell carcinoma of the bladder occurs frequently, its presentation as a symptomatic solitary bony metastasis is rare. Furthermore, presentation as a solitary distal metastasis with osteolytic and osteoblastic components is almost a novelty. We present such a case, which is additionally unusual in that the primary lesion in the bladder and the metastasis were resectable. A symptomatic solitary bony metastasis as the presenting sign of an asymptomatic transitional cell carcinoma of the bladder is infrequent, with only 1 case reported in the literature.1·2 Herein we report a case of transitional cell carcinoma of the bladder, presenting as a solitary, mainly osteolytic lesion in the fibula. CASE REPORT
An 88-year-old white widow presented with a 3-month history of an increasingly painful swelling over the lateral aspect of the left lower leg. She gave no history of trauma or any other problems. Medical history was unremarkable except for an appendectomy 53 years previously. No significant family or social history was elicited. Physical examination revealed an anemic woman with a 10 cm. ovoid swelling over the distal end of the left fibula with signs of local inflammation. Radiographs of the left ankle showed a large osteolytic lesion, with an element of osteoblastic activity of the distal portion of the fibula (see figure). An isotope bone scan showed no other bone lesions. A bone biopsy demonstrated fragments of bone heavily infiltrated by deposits of partly necrotic transitional cell carcinoma. Further questioning of the patient revealed 1 episode of hematuria, mainly terminal, approximately 8 weeks previously. An excretory urogram showed an irregular filling defect on the left side of the bladder, in addition to a duplex left kidney. Cystoscopy confirmed a moderate-sized papillary tumor that was totally resectable. Histopathological review showed the lesion to be of the same configuration as that of the left ankle. The fibular lesion was treated by megavoltage radiation therapy, which failed to control its growth and a through-knee amputation of the left leg had to be performed. When seen in the outpatient clinic 1 year later the patient was free of disease. DISCUSSION
Bony involvement by transitional cell carcinoma of the bladder is relatively common. Goldman and associates reviewed 51 patients with transitional cell carcinoma of the bladder and found that 28 per cent had bony metastases, the majority Accepted for publication April 29, 1983. * Requests for reprints: Department of Medicine, University of Colorado Medical Center, 4200 East Ninth Ave., Box B171, Denver, Colorado 80262.
Anteroposterior and lateral radiographs of left ankle
involving the vertebral column. 1 However, involvement of distal bones is rare and usually occurs late. 3 Our case is most unusual in that the original presentation was from a single metastasis in a distal bone, the lesion was osteolytic and osteoblastic, and the primary lesion in the bladder, as well as the metastasis, was resectable. REFERENCES
1. Goldman, S. M., Fajardo, A. A., Naraval, R. C. and Madewell, J.
E.: Metastatic transitional cell carcinoma from the bladder: radiographic manifestations. Amer. J. Roentgen., 132: 419, 1979. 2. Feggetter, J. G.: An osteolytic lesion as a presentation of bladder carcinoma. Brit. J. Urol., 48: 254, 1976. 3. Mullin, E. M., Glenn, J. F. and Paulson, D. F.: Lesions of bone and bladder cancer. J. Urol., 113: 45, 1975.
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THE JOURNAL OF UROLOGY
Copyright © 1983 by The Williams & Wilkins Co.
BLADDER CARCINOMA PRESENTING AS A SOLITARY BONY METASTASIS T. I. MUGHAL,* R. H. PHILLIPS AND W. A. ROBINSON ;
From the Sir Stanford Cade Oncology Unit, Westminister Hospital Medical School, London, England
ABSTRACT
Although bony involvement by transitional cell carcinoma of the bladder occurs frequently, its presentation as a symptomatic solitary bony metastasis is rare. Furthermore, presentation as a solitary distal metastasis with osteolytic and osteoblastic components is almost a novelty. We present such a case, which is additionally unusual in that the primary lesion in the bladder and the metastasis were resectable. A symptomatic solitary bony metastasis as the presenting sign of an asymptomatic transitional cell carcinoma of the bladder is infrequent, with only 1 case reported in the literature.1·2 Herein we report a case of transitional cell carcinoma of the bladder, presenting as a solitary, mainly osteolytic lesion in the fibula. CASE REPORT
An 88-year-old white widow presented with a 3-month history of an increasingly painful swelling over the lateral aspect of the left lower leg. She gave no history of trauma or any other problems. Medical history was unremarkable except for an appendectomy 53 years previously. No significant family or social history was elicited. Physical examination revealed an anemic woman with a 10 cm. ovoid swelling over the distal end of the left fibula with signs of local inflammation. Radiographs of the left ankle showed a large osteolytic lesion, with an element of osteoblastic activity of the distal portion of the fibula (see figure). An isotope bone scan showed no other bone lesions. A bone biopsy demonstrated fragments of bone heavily infiltrated by deposits of partly necrotic transitional cell carcinoma. Further questioning of the patient revealed 1 episode of hematuria, mainly terminal, approximately 8 weeks previously. An excretory urogram showed an irregular filling defect on the left side of the bladder, in addition to a duplex left kidney. Cystoscopy confirmed a moderate-sized papillary tumor that was totally resectable. Histopathological review showed the lesion to be of the same configuration as that of the left ankle. The fibular lesion was treated by megavoltage radiation therapy, which failed to control its growth and a through-knee amputation of the left leg had to be performed. When seen in the outpatient clinic 1 year later the patient was free of disease. DISCUSSION
Bony involvement by transitional cell carcinoma of the bladder is relatively common. Goldman and associates reviewed 51 patients with transitional cell carcinoma of the bladder and found that 28 per cent had bony metastases, the majority Accepted for publication April 29, 1983. * Requests for reprints: Department of Medicine, University of Colorado Medical Center, 4200 East Ninth Ave., Box B171, Denver, Colorado 80262.
Anteroposterior and lateral radiographs of left ankle
involving the vertebral column. 1 However, involvement of distal bones is rare and usually occurs late. 3 Our case is most unusual in that the original presentation was from a single metastasis in a distal bone, the lesion was osteolytic and osteoblastic, and the primary lesion in the bladder, as well as the metastasis, was resectable. REFERENCES
1. Goldman, S. M., Fajardo, A. A., Naraval, R. C. and Madewell, J.
E.: Metastatic transitional cell carcinoma from the bladder: radiographic manifestations. Amer. J. Roentgen., 132: 419, 1979. 2. Feggetter, J. G.: An osteolytic lesion as a presentation of bladder carcinoma. Brit. J. Urol., 48: 254, 1976. 3. Mullin, E. M., Glenn, J. F. and Paulson, D. F.: Lesions of bone and bladder cancer. J. Urol., 113: 45, 1975.
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