URETHRAL RECURRENCE OF TRANSITIONAL CELL CARCINOMA IN A FEMALE PATIENT AFTER CYSTECTOMY AND ORTHOTOPIC ILEAL NEOBLADDER

Abstract

A 63-year-old woman presented elsewhere with a unifocal pT1, G3 transitional cell carcinoma at the bladder base in 1995. She underwent urethral sparing cystectomy and ileal neobladder. Intraoperative frozen section from the proximal urethra did not demonstrate tumor involvement. Final histological examination revealed pT1, pN2, G3 transitional cell carcinoma. Adjuvant chemotherapy was not given. In 1998 the patient had symptoms of obstructive voiding due to a 3 3 3 cm. solid mass at the neobladder-urethra anastomosis (see figure). After 6 cycles of methotrexate, vinblastine, doxorubicin and cisplatin and a transient tumor size reduction, the patient was referred to us for local tumor progression. Endoscopy identified a tumor at the neobladder-urethra anastomosis. Magnetic resonance imaging demonstrated a 2.5 3 1 cm. tumor infiltrating the anterior vaginal wall. With a combined abdominovaginal approach complete removal of the tumor was accomplished, including removal of the introitus and vagina, lower third of the ileal neobladder and entire urethra. The ileal neobladder was converted to a continent cutaneous urinary diversion with umbilical stoma. Histopathological examination revealed poorly differentiated transitional cell carcinoma and tumor-free margins of resection. Two months later multiple hepatic metastases were diagnosed and the patient died 3 months later.