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Bladder metastases of appendiceal mucinous adenocarcinoma: a case presentation
© Taverna et al; licensee BioMed Central Ltd. 2010
Received: 7 August 2009
Accepted: 23 February 2010
Published: 23 February 2010
Appendiceal adenocarcinoma is rare with a frequency of 0.08% of all surgically removed appendices. Few cases of appendiceal carcinoma infiltrating the bladder wall for spatial contiguity have been documented.
A case is reported of a 45-years old woman with mucinous cystadenocarcinoma of the appendix with bladder metastasis. Although ultrasonography and voided urinary cytology were negative, abdomen computed tomography (CT) scan and cystoscopy and subsequent pathological examination revealed a mass exclusively located in the anterior wall of the bladder. Histopathology of the transurethral bladder resection revealed a bladder adenocarcinoma [6 cm (at the maximum diameter) × 2,5 cm; approximate weight: 10 gr] with focal mucinous aspects penetrating the muscle and perivisceral fat. Laparotomy evidenced the presence of a solid mass of the appendix (2,5 cm × 3 cm × 2 cm) extending to the loco-regional lymph nodes. Appendectomy and right hemicolectomy, linfoadenectomy and partial cystectomy were performed. The subsequent pathological examination revealed a mucinous cystadenocarcinoma of the appendix with metastatic cells colonising the anterior bladder wall and several colic lymph nodes.
The rarity of the appendiceal carcinoma invading the urinary bladder and its usual involvement of nearest organs and the posterior bladder wall, led us to describe this case which demonstrates the ability of the appendiceal cancer to metastasize different regions of urinary bladder.
The appendiceal adenocarcinoma invading the urinary bladder is extremely rare [1–4], and it is very difficult to be diagnosed before the surgical inspection. Here we describes a case of appendiceal cystoadenocarcinoma metastising the bladder anterior wall diagnosed in a patient with monosymptomatic episodes of gross hematuria. Our diagnostic schema and the adopted pharmacological treatment are also discussed.
Appendiceal adenocarcinoma is rare with a frequency of 0.08% of all surgically removed appendices. To our best knowledge it was reported few cases of appendiceal carcinoma infiltrating the bladder wall for spatial contiguity [1–11]. It is recognized that tumours of the pelvic organs (i.e. ovary, colon and rectum) may invade the urinary bladder [10, 11]. In these cases symptoms presenting complaints urinary disease and eventually symptoms referable to the gastrointestinal tract . All patients undergo appendectomy, segmental bladder resection or cystectomy and segmental caecal resection or right colectomy [5–9]. In our case the bladder neoplasia was found of metastatic origin and not locally invading from the primary appendiceal tumoural site. The primary lesion of the appendix was nearby the posterior bladder wall without local invasion. Thus confirming that the anterior bladder lesion was a secondary localization of appendiceal carcinoma. Ultrasonography and abdomen enhanced CT scan unrevealed any gastrointestinal primary lesion. We therefore decided for a partial cystectomy, because metastases were found in the anterior portion of the bladder, completely unconnected from the primary appendiceal tumour. We have considered the possibility of a synchronous cancer, but the overlap between the morphologic features of the tumour and the clinical characteristics of the disease strongly support the metastatic nature of the bladder adenocarcinoma. In addition, we found multiple metastasis at the level of colic lymph-nodes and not at the level of bladder lymph-nodes. This supports the fact that the bladder lesion is of metastatic origin and not definable as a primary tumoural lesion. Some explanations of the involved metastatic pathways might linked to the fact that tumoural clones may have embolized lymphatic vessels located under the peritoneal serous membrane of the appendiceal-caecum region, and after the colonization of a high number of loco-regional lymph-nodes, tumoural cells might have reach the peri-bladder lymph-nodes. However, this hypothesis is in contrast with the fact that no new bladder lesions have been found during the follow-up of the patient. In our presented case the anatomical characteristics of non contiguity between the anterior bladder wall and the appendix, caecum and peritoneum, and the different neoplastic lymph-node development between bladder and colic cancer led us to hypothesize that the metastatic pathway was haematogenous.
The rarity of the appendiceal carcinoma invading the urinary bladder and its usual involvement of nearest organs and the posterior bladder wall, led us to first describe this case which demonstrates the ability of the appendiceal carcinoma to metastasise different portions of urinary bladder.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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