Peritoneal carcinomatosis in urinary bladder cancer: A case report

Transitional cell carcinoma (TCC) is associated with malignant tumors that arise from stem cells near the basement membrane of the epithelial bladder surface. Exposure of carcinogens to the urothelium leads to genetic alterations in cells, increasing the malignant potential. Of the different environmental exposures, cigarette smoke is considered the greatest risk factor in the development of TCC in the United States. Pathological tumor growth patterns are classified as papillary (most common), sessile/mixed, or nodular, with TCC often arising via the flat or papillary pathways. Most commonly, TCC involves the papillary pathway, with formation of a tumor projecting into the bladder lumen and possible invasion of the lamina propria and bladder muscle. Constitutional symptoms such as weight loss, fatigue, along with lower abdominal pain or bone pain are often indicative of metastatic disease and poor prognosis. Metastasis of TCC most commonly occurs to the lungs, liver, or bone. Metastasis to the peritoneum with abdominal ascites, however, is very rare. In our case, TCC with peritoneal carcinomatosis and ascites in a 48-year-old male smoker can be appreciated. Abdominal pain with nausea, weight loss, and hematuria lead to computed tomography (CT) scan, which depicted ascites, omental thickening, and soft tissue mass in the urinary bladder. Biopsy and pathologic cytology revealed high-grade TCC with papillary morphology. Transitional cell carcinoma with peritoneal carcinomatosis is a rare cause of bladder carcinoma. Poor prognosis is due to advanced disease stage, poor performance status, and metastasis. Effective treatment often cannot be initiated, because of the grim presentation. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 11, November 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(11):749–753. www.ijcasereportsandimages.com Khosla et al. 749 CASE REPORT OPEN ACCESS Peritoneal carcinomatosis in urinary bladder cancer: A case report Manraj Khosla, Ali Imran, Panagiotis Fidias