This is a 52-year-old male patient who came to our department for macroscopic hematuria with no other added symptom for approximately 6 months.
The patient had a previous positive medical history for systemic lupus erythematosus (SLE) for approximately 30 years.
In the initial phase of the disease, the patient received treatment with Cyclophoamide with unknown duration and dosage.
It also has pulmonary fibrosis secondary to SLE, requiring permanent supplemental oxygen and bronchodilators.
Physical examination did not reveal any alteration related to the current disease.
Laboratory tests, including blood chemistry, were normal.
The general urine test confirmed the presence of hematuria with no data suggesting urinary infection.
Urocultiva was negative.
Chest X-ray showed data consistent with significant pulmonary fibrosis with no evidence of metastatic lesions.
Abdominal ultrasound showed a solid, irregular tumor, dependent on the bladder dome of 9 x 7 cm. The study of Nuclear Magnetic Resonance (NMR) showed a mass of 8.89 x 5.37 cm bladder wall invasion.
Cystoscopy confirmed the above findings and transurethral biopsies revealed a poorly differentiated bladder carcinoma.
1.
Due to the size of the tumor and its invasive aspect, the initial treatment option was to perform radical cystectomy; however, the patient's general condition and lung problem prevented this approach.
Therefore, the patient was treated with partial cystectomy and pelvic lymphadenectomy.
Histopathological analysis showed a small cell carcinoma of the bladder of 8.5 x 6.9 x 5 cm with invasion of the muscle layer and negative surgical resection margins.
A left pelvic ganglion was discovered due to metastasis.
The diagnosis was confirmed by immunohistochemistry, which was positive for chromogranin and synaptophysin.
P53 staining was also positive.
1.
After surgery, the patient was programmed to receive adjuvant therapy with gemcitabine chemotherapy and vomiting; however, she received the first cycle, presented intense data of gastrointestinal toxicity (discontinued and discontinued).
The evolution was good, but 6 months after surgery she presented a new episode of hematuria and fistula v-cutaneous secondary to tumor recurrence.
For this reason palliative treatment was initiated with gastrointestinal diversion through ileostomy.
