Case Report: Primary squamous cell carcinoma of the bladder secondary to chronic renal fungal ball and recurrent polymicrobial urinary tract infections.

Andrew Keller,Ahmad Ali,Arief Mulyadi,Benjamin Shepherd

doi:10.12688/f1000research.6307.1

Abstract

IntroductionSquamous cell carcinoma (SCC) of the bladder is a rare malignancy in Western countries accounting for only 5% of all primary bladder cancers. Chronic irritation is the predominant risk factor, with chronic infections, bladder stones and long term catheterisation common precursors. The highest incidence of SCC occurs in patients with spinal cord injuries who rely on indwelling or self-catheterisation for bladder drainage. We report a case of primary SCC of the bladder secondary to a fungal ball located in the renal pelvis.Case reportA 72 year-old lady was referred to our unit for further investigation of recurrent polymicrobial urinary tract infections associated with intermittent flank pain and complicated by sepsis. Investigations into the cause for her recurrent urinary tract infections identified a mass in her left renal pelvis. Pyeloscopy demonstrated no tumour, but a fungal ball. Attempts to clear the fungal ball via pyeloscopy resulted in recurrent intensive care unit (ICU) admission for urosepsis. Several months after her last pyeloscopy she returned with haematuria. Cystoscopy at this time revealed a large bladder mass. Biopsy revealed primary SCC of the bladder invading muscle. At cystectomy the mass had invaded pubic bone and was unresectable and a palliative ileal conduit was formed. The patient passed away less than 4 months following diagnosis.ConclusionWe report what we believe to be the first case of primary SCC of the bladder secondary to a renal pelvis fungal ball. Despite frequent surveillance of her urinary tract the tumour developed rapidly and was unresectable at diagnosis.

Highlights

Squamous cell carcinoma (SCC) of the bladder is a rare malignancy in Western countries, accounting for only about 5% of all primary bladder cancers[1]
Chronic irritation is the predominant risk factor, with recurrent infections, bladder stones and long term catheterisation common precursors, and the highest incidence occurring in patients with spinal cord injuries who rely on indwelling or self-catheterisation for bladder drainage[2,3]
We report a case of primary SCC of the bladder secondary to a fungal ball located in the renal pelvis

Summary

Conclusion

We believe, the first documented case of primary SCC of the bladder secondary to an upper tract fungal ball. Despite the patient being under close urological surveillance for her fungal ball at the time of tumour development, the cancer demonstrated transmural invasion at initial diagnosis and was surgically unresectable. The disease was rapidly progressive and the patient passed away fewer than four months following diagnosis. Consent Written informed consent for publication of their clinical details and clinical images was obtained from the patient’s of kin. Author contributions AK writing and literature review. BS provided histological images and contributed to article structure. AM helped in writing of the article and provided clinical images. All authors have read and approved the final proof of this manuscript. Grant information The author(s) declared that no grants were involved in supporting this work

Introduction

Discussion

Findings

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