Implantation of Colorectal Cancer from the Upper Urinary Tract to the Bladder via Urine

Taketo Kawai,Haruki Kume,Yoshiyuki Akiyama,Masaki Nakamura,Daisuke Yamada,Naohiro Makise,Yuta Yamada,Katsuhiro Makino,Yusuke Sato,Tetsuo Ushiku,Takahiro Oshina,Motofumi Suzuki,Takeru Morishige

doi:10.31487/j.cor.2020.08.22

Abstract

Although the implantation of urothelial carcinoma from the upper urinary tract to the bladder occurs frequently, the involvement of cancers of other histologic types is rare. Here, we present an unusual case of intravesical recurrence, following ureteral invasion, by colorectal cancer. A 69-year-old woman developed a local recurrence of colorectal cancer involving the sigmoid colon and left ureter. The patient underwent a sigmoidectomy and left nephroureterectomy. Six months later, bladder tumors were observed, and a transurethral resection was performed. Histological examination of the bladder tumors revealed adenocarcinoma consistent with the findings of the colorectal cancer that had been previously resected. The most probable mechanism of intravesical recurrence would be the implantation of colorectal cancer cells from the upper urinary tract to the bladder via urine.

Highlights

The implantation of upper urinary tract urothelial carcinoma (UTUC) to the bladder occurs frequently, with intravesical recurrence developing in 40-50% of patients after a radical nephroureterectomy [1]
The most probable mechanism of intravesical recurrence would be the ureteral intraluminal spread of colorectal cancer cells via urine since an initial urinary cytology had revealed positively staining carcinoma cells and that cancer had not been found in the bladder prior to nephroureterectomy
The results of the present case suggest that metastatic bladder tumors with histological types other than urothelial carcinoma show red fluorescence levels as high as those in primary bladder urothelial carcinoma with photodynamic diagnosis (PDD)

Summary

Introduction

The implantation of upper urinary tract urothelial carcinoma (UTUC) to the bladder occurs frequently, with intravesical recurrence developing in 40-50% of patients after a radical nephroureterectomy [1]. The implantation of other histological types of cancer from the upper urinary tract to the bladder is rare. Several studies have reported the recurrence of colorectal cancer in the urinary bladder after a partial cystectomy, intraluminal spread from the upper urinary tract to the bladder remains unreported [3, 4]. We describe an unusual case of an intravesical recurrence following ureteral invasion by colorectal cancer and discuss the possible mechanism involved. A follow-up abdominal CT revealed three tumors, 1 cm in size, in the bladder (Figure 2b). At the time of writing, cancer recurrence has not been observed four months after TURBT

Discussion

Conclusion