Cavitatory Pulmonary Metastasis in Superficial Transitional Cell Carcinoma of Urinary Bladder

Cavitatory Pulmonary Metastasis

Abstract

Introduction: superficial bladder cancers represent 70-75% of all bladder malignancies. The frequency of metastatic cavitation tumours in lung are 2-5%. Case Presentation: We present a 65 years elderly gentleman a treated case of superficial bladder cancer who presented after sixteen months of follow up with cough and haemoptysis. Sputum was positive for malignant cells on cytology. CT guided biopsy of the lung lesions showed transitional cell carcinomatous deposits. He was started on gemcitabine and cisplatin based chemotherapy. After six cycles a repeat CT scan showed complete resolution of lesions Conclusion: In this case, we observed superficial transitional cell carcinoma bladder with well-defined cavitatory lesions which were transitional cell carcinoma on biopsy. After initiation of cisplatinum based chemotherapy, patient showed complete resolution of metastatic lesions emphasizing role of multi-agent chemotherapy in metastatic disease. This case highlights the role of adjuvant chemotherapy in superficial urinary bladder cancer with lung metastasis leading to complete resolution of the lesions, thereby emphasizing role of phase specific chemotherapy in high fraction tumours. Cisplatinum has been approved as first line agent in urinary bladder carcinoma along with gemcitabine and has shown commendable results in improving overall survival and quality of life. In this case it has outdone itself in a metastatic setting with extensive lung metastasis and has shown that even metastatic settings should be given a trial of cisplatinum based chemotherapy irrespective of the widespread nature of the disease.