A 36-year-old woman, allergic to codeine and tetratic alopecia, with a history of hypothyroidism, thalassemia minor, occipital areata, underwent sinus pygium surgery, and underwent normal vaginal delivery.
She was referred from the last pregnancy consultation where hematuria was present, due to intermittent pain radiating to genitals, associated with dysuria, pollakiuria and bladder tenesmus, with a positive false self-limiting test.
Urological history revealed recurrent cystitis every year in the last 7 years, managed in primary care.
In the last two months, her irritation symptoms increased with daytime frequency every hour and nighttime 7 times, explaining occasional episodes compatible with pneumaturia, without obstructive symptoms of the lower urinary tract.
Normal regular menstruations.
On examination, abdominal masses were not detected, renal percussion was negative, external genitalia were normal, there was no pain on the bimanual tattoo in the anterior genitalia.
Analytically, high levels of ß-HCG (557UI/l), normal carmine enteric antigen (63.4 ng/ml), Ca 19-9 (311 IU/ml) and Ca 125 were found in blood.
Hb: 11.2 g/dl, 15200 leukocytes/mm3, normal rest including coagulation study.
Test of repeated pregnancy in urine false positive and analysis with intense pyuria, negative nitrites and more than 200 mg / field.
Abdominal ultrasound showed hyperechogenic irregular thickening of the fundus and anterior bladder wall due to probable neoplasia, with the kidneys, uterus and adnexa being normal.
Intravenous urography showed a large left hemivesical filling defect, with normal upper urinary tract.
Urethrocystoscopy was performed confirming a solid tumor with a prominent aspect in the left lateral face, fundus, anterior face and left hemitrigone to the bladder neck.
The study was completed by MRI scan of the pelvis showing a severe thickening with bladder wall thickening with no involvement of the perivesical fat, with presence of adenoid in the right iliac cupula 15
The preoperative chest X-ray was normal.
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A transurethral resection of the tumor was performed, with pathological report of high grade invasive transitional carcinoma of high grade, without differentiation bladder origin G3T2, immunohistochemical compatible with bladder origin CK12 (CK).
Two weeks after surgery the patient had two rapidly growing skin lesions.
A solid nodule in the frontal region, ulcerated and bleeding on the face, and another elevated lumbar lesion of growth manifest.
Cutaneous metastases were suspected by excision of cutaneous metastases with pathological report of a solid neoplasm compatible with skin, underlying soft tissues including muscle and fascia, affecting the deep edges of frontal bone metastases, with immunophenotype
Chemotherapy was initiated with cisplatin and gemcitabine fortnightly.
The left pair and acetbulum after two months showed a metastatic burst with multiple implants at the left inframammary level, glútea, psoas, osteolytic in the left anterior ischial metastasis of the left ventricle.
Locally, the extension of the bladder tumor involves the left sigma and the distal ureter.
The patient under palliative treatment died three months after the onset of metastatic cutaneous disease.
