Transitional Cell Carcinomas in the Bladder and Ovary: Unusual Primary Association or Metastatic Lesions?

Abstract

Transitional cell carcinoma (TCC) has been recognized as one of the main epithelial carcinomas of the ovary. It is a rare tumor, but its true incidence remains unknown. It is characterized by its histologic resemblance to TCC of the bladder. The coincident association of TCCs of the ovary and the bladder involves two possible diagnoses: the ovarian TCC could be a primary TCC, or it could be the result of metastasis of a bladder TCC. We present a case of TCC of the ovary in a patient who had previously suffered from high-grade superficial transitional cell urinary bladder cancer. A 42-year-old woman was admitted to Ibn-Sina hospital with hematuria. She underwent transurethral resection of the bladder (TURB) for diagnostic and therapeutic purposes. Histopathologic analysis showed a TCC pT1b G3. Concurrent ultrasound examination and abdominal computed tomography (CT) showed no other tumors in the pelvis or abdomen. Further superficial papillary tumors involving the bladder were resected at the 24- and 36-month regular follow-ups. CT scans performed as part of the follow-up procedures failed to detect any other pelvic or abdominal tumors. TURB was performed on both occasions, but the patient refused intravesical chemotherapy. The patient was hospitalized for abdominal pain 2 months after the last resection (38 months after the initial resection). Pelvic CT scan revealed an 11.0-cm cystic mass in the pelvis (Figure 1). The results of bladder imaging were normal. Laparoscopic resection of the ovarian tumor was performed, including a left salpingooophorectomy, omentectomy, and sampling of ascites fluid. The right ovary was macroscopically normal. Pathologic examination of the monocystic lesion revealed multiple small papillary formations partly covering the external and internal surfaces of the cyst. Microscopic examination showed ovarian tissue infiltrated by malignant transitional epithelium composed of blunt papillae lined with stratified epithelium with solid nests. Periodic acid-Schiff-positive microcystic spaces were also identified (Figure 2). The cells had round or ovoid nuclei, with nucleoli or longitudinal grooves, and frequent mitosis. The tumor was extensively sampled, and no components of other ovarian epithelial tumors, such as serous or endometrioid adenocarcinomas, were found. The presence of a benign or borderline Brenner component was also excluded. The omentum was free of tumor and the cytology of the ascites fluid was negative for malignant cells. This ovarian tumor was indistinguishable from the previous TCC of the bladder, and was initially diagnosed as an ovarian metastasis from the urinary bladder carcinoma. Indeed, the TURB examination performed at 36 months demonstrated the same features, with papillary structures lined