A 60-year-old man presented to our clinic in January 2009 with occasional macroscopic hematuria of two years duration.
Ten months after the first episode, the patient began to have polachiuria and dysuria. Two months later, an ultrasound scan showed thickening of the right bladder wall hydronephrosis.
An extension study was carried out by means of TAC-abdominal and bone scintigraphy, not detecting lesions suggestive of metastasis and confirming the findings and signs of metastasis.
In February 2009, she received surgical treatment by transurethral resection of the bladder with diagnosis of bladder carcinoma 27procalcitoid derivation of the muscular layer and presence of foci of lymphovascular embolization, so a cyst was indicated 2009.
The pathology report revealed a diffuse epithelial growth neoformation with some nests or cords, consisting of small cells, scarce cytoplasm and large nucleus, pleoplasma polylobulated.
In addition, some areas were observed where the nuclei were more pleomorphic, polylobulated, large and highly hyperchromatic, compared to the rest of the tumor population.
Pictures of mitoses, typical and atypical as well as apoptosis were frequent.
Located cells reached the bladder wall.
The immunohistochemical study was positive in 100% for cytokeratin-7 and 70% for cytokeratin-20 and high molecular weight cytokeratin with diffuse character.
The definitive diagnosis was poorly differentiated, high grade urothelial carcinoma, variant of malignant cells.
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Then, the patient was referred to the outpatient unit where he started adjuvant chemotherapy with Cisplatin and Gemcitabine (4 cycles) which ended in August 2009.
In March 2010, in a control examination and the patient was asymptomatic, lesions suggestive of spinal metastasis were observed, so a spinal MRI was performed, which reported possible metastases at D103, D8, and D1.
Bone scintigraphy and PET-CT were inconclusive, so that evolutionary control was achieved in three months.
This control showed growth of already known bone lesions that were biopsied and were inconclusive for malignancy.
In September 2010, PET-CT was repeated, not showing signs of pathological bone uptake, but multiple lymph nodes were found in the left axillary region, perivascular mediastinal, subcarinal and internal retroperitoneal level, as well as in the internal mammary region.
A new puncture with vertebral needle was performed and reported as a metastatic urothelial neoplasm compatible with urothelial hyperplasia.
Biopsy of breast lymph nodes was also performed, which were also reported as compatible with metastatic lesions originating from urothelial hyperplasia.
At this time, a new line of chemotherapy was initiated with Paclitaxel and Carboplatino, on a weekly basis, with a total of 6 cycles, which ended in January 2011.
Half of the chemotherapy treatment received a new control CT scan in which the disease was diagnosed and treated.
On February 17, 2011, a CT scan of reassessment revealed moderate-severe right hydronephrosis with nodular image extruded in the ureteral lumen suggestive of a new tumor lesion.
The patient also had contralateral kidney function and increased plasma creatinine to 2.9 ng/mL.
It was decided to place a right percutaneous nephrostomy with placement of an antegrade ureteral double J catheter.
During this admission he suffered an inferoposterior AMI and right ventricle treated by primary angioplasty effectively.
Finally, in mid-March 2011 the patient died.
