Case Report: Metastatic Signet-Ring-Cell Carcinoma of the Bladder From Breast Invasive Lobular Carcinoma Detected by Computed Tomography

Xiaoxiang Jin,Haibin Tang,Gang Chen,Hualin Chen

doi:10.3389/fonc.2022.835487

Abstract

Secondary bladder tumors are relatively rare among all bladder tumors, while bladder metastases from breast cancer have been rarely reported. Furthermore, signet-ring differentiation may appear in the metastases from a breast invasive lobular carcinoma regardless of whether the primary breast tumor had signet-ring cells, which may cause diagnostic uncertainty. We report a case of a 55-year-old female patient with diffuse bladder thickening as the chief complaint and no specific clinical manifestations. While the cystoscopy showed multiple scattered red protuberances, the biopsy suggested signet-ring-cell carcinoma. The gastroscopy results suggested poorly differentiated adenocarcinoma with signet-ring cells. Considering the patient’s history of invasive lobular carcinoma of the breast, chronic myeloid leukemia, and metastatic endometrial carcinoma from the breast, we performed an immunohistochemical analysis and the results indicated that signet-ring-cell carcinomas of the stomach and bladder originated from the invasive lobular carcinoma of the breast. We performed positron emission tomography/computed tomography and the results showed that there were multiple bone metastases already present. This was the first English case report of invasive lobular carcinoma of the breast metastasizing to the uterus, stomach, bladder, and bones with multiple signet-ring-cell variations. This study shares our reasons for misdiagnosing and opinions on diagnosing and treating for this kind of cases.

Highlights

Primary bladder tumor is the most common tumor of the urinary system, while secondary tumors of the bladder are rare, accounting for less than 2% of all bladder neoplasms [1]
Based on rapidly progressive aggravations of the bladder wall thickening in the computed tomography (CT) manifestations, we considered that there was a possibility of malignancy and we suggested that a cystoscopy should be performed immediately even though there were no significant clinical symptoms with normal renal function
We performed positron emission tomography (PET)/CT scans, and the results showed that multiple bone metastases were already present

Summary

INTRODUCTION

Primary bladder tumor is the most common tumor of the urinary system, while secondary tumors of the bladder are rare, accounting for less than 2% of all bladder neoplasms [1]. In March 2021, the pelvic CT showed a significant thickening of the bladder wall (Figure 2C). The patient still did not experience any chief urinary symptoms and the creatinine and eGFR were normal (Supplementary Figures 1A, B) This time, we still didn’t realize it was malignant. Considering there were only slowly aggravated thickening of the bladder wall and the renal function was normal the whole time, we still cautiously suggested her active surveillance without placements of ureteral stents or nephrostomy tubes. Based on rapidly progressive aggravations of the bladder wall thickening in the CT manifestations, we considered that there was a possibility of malignancy and we suggested that a cystoscopy should be performed immediately even though there were no significant clinical symptoms with normal renal function. What’s more, the patient had no chief complaint in urinary system with normal renal function the whole time. and the patient was advised to follow up the renal function every month and the enhanced CT every 3months

DISCUSSION

Findings

CONCLUSIONS

ETHICS STATEMENT