A rare metastatic urinary bladder manifestation originating from a gastric adenocarcinoma was documented in a 48-year-old male patient who presented with severe abdominal pain, hematemesis, and obstructive urological symptoms.
This case, detailed in Cureus, brings forward an exceptional clinical intersection between gastrointestinal malignancy and urological pathology. Secondary bladder involvement from distant primary tumors accounts for roughly 2% to 3% of all malignant bladder tumors, making this specific presentation an extreme rarity in oncology.
In Plain English: The Clinical Takeaway
- Signet-Ring Cell Carcinoma: A histological subtype of stomach cancer characterized by individual cells containing mucin vacuoles that push the nucleus to the side, known for aggressive dissemination.
- Bilateral Hydronephrosis: Swelling of both kidneys caused by a backpressure of urine, which in this patient resulted from circumferential bladder wall thickening obstructing normal flow.
- Transurethral Resection of the Bladder (TURB): A minimally invasive surgical procedure performed through the urethra to remove abnormal tissue masses from the bladder wall.
Patient Presents with Epigastric Pain and Hematemesis
The patient arrived at the emergency department of a tertiary-care center experiencing persistent epigastric pain alongside hematemesis, or vomiting blood. These digestive complaints were accompanied by secondary urological symptoms, including macroscopic haematuria and bilateral low back pain.
Initial clinical examination revealed abdominal distension suggestive of ascites, rendering palpation difficult. Gastroscopy performed one day after admission identified a large ulcerated mass originating from the angulus and extending along the lesser curvature up to the cardia. Pathological examination confirmed an infiltrating gastric adenocarcinoma characterized by signet-ring cells.
CT Scans Reveal Gastric Mass and Bladder Thickening
Subsequent computed tomography of the chest, abdomen, and pelvis revealed a primary gastric wall process measuring over 136 mm, alongside enlarged regional lymph nodes and peritoneal carcinomatosis. The scan also exposed a circumferential thickening of the bladder wall reaching a maximum thickness of 20 mm, accompanied by bilateral dilation of the ureters and pelvicalyceal system.
Initial laboratory assessments demonstrated impaired renal function, with a creatinine level of 35 mg/L and a glomerular filtration rate of 21 mL/min. Placement of a three-way urinary catheter reduced the outflow obstruction, causing postoperative creatinine to drop to 19 mg/L and the glomerular filtration rate to recover to 38 mL/min.
Cystoscopic Evaluation and Histological Confirmation
Cystoscopy demonstrated a permeable urethra alongside an infiltrative, rigid, and multinodular bladder mucosa with focal hemorrhaging. Biopsies executed via a monopolar resectoscope confirmed a poorly differentiated carcinomatous process. Immunohistochemical profiling revealed positivity for CK7 and CK20, while remaining negative for P63 and GATA3, successfully eliminating a primary urothelial origin and verifying the gastric metastasis.
Researchers said that metastatic spread to the bladder can occur via hematogenous or lymphatic routes, or via transcoelomic extension following intraperitoneal tumor cell migration. In this specific scenario, retrograde lymphatic or hematogenous dissemination alongside transcoelomic seeding were both considered plausible vectors.
Postoperative Management and Prognostic Outlook
Following successful transurethral resection of the bladder tumor and catheter removal, the patient was initiated on a systemic chemotherapy protocol utilizing the FOLFOX regimen. Subsequent clinical evaluations demonstrated partial regression of the bladder wall infiltration on radiological monitoring alongside complete normalization of renal function parameters.
The case serves as a critical reminder for clinicians and urologists to maintain a broad differential diagnosis when oncological patients present with unexpected urological manifestations.
References
- Cureus: A Rare Case of Urinary Bladder Metastasis From Gastric Adenocarcinoma: A Case Report
- International Agency for Research on Cancer: Global Cancer Statistics Reports
- World Health Organization: Gastric Cancer Epidemiological Updates
