A 78-year-old man presented with macroscopic monosymptomatic hematuria.
His history included hypertension and prostate adenocarcinoma (T3, N0, M0) treated with complete hormonal blockade.
The patient was initially studied by the urology service of another hospital.
Different analytical and imaging studies were performed.
In May 2004, transurethral resection of the bladder (TUR) of several papillary tumors on the left side was performed.
The pathological diagnosis was grade III transitional cell carcinoma, performing intravesical chemoprophylaxis with mitomycin.
Three months later, the patient came to the emergency department of our hospital with a history of overt hematuria with clots of 18 hours of evolution, with mild anemia being the most common laboratory finding.
Chest and abdominal X-rays showed no significant findings.
An intravenous urography showed a filling defect and rigidity of the left bladder wall, suggesting a tumoral inversion.
The patient was discharged after a favorable evolution of hematuria with bladder lavage, awaiting a new TUR, coming before the scheduled appointment, for presenting new hematuria.
In October 2004, transurethral resection (TURP) was performed, finding incrusting lesions in the dome and left lateral aspect of the bladder.
The dome lesion was nodular. The lesion was papillary on the lateral side. At the same time, there were papular lesions, nodular, throughout the bladder.
The extension study using CAT scans showed minimal left lateral irregularity of the bladder.
The pathological study was compatible with small cell neuroendocrine tumor.
Microscopically, there was a monomorphous population of small round cells with hypercrosome nuclei, without evident isolation, with numerous mitotic figures.
These lesions grew diffusely, preserving the subepithelial connective tissue, muscularis propria.
He also had extensive areas of tumor necrosis, without clear images of vascular permeations.
Immunohistochemistry showed positivity for cytokeratins (AE1/AE3), chromogranin and enolase and negativity for leukocyte common antigen (LCA), CK7, CK20, CAM 5.2.
A month and a half later, our hospital institution began chemotherapy treatment combining cisplatin with etopoxide.
At the end of three cycles of treatment, a new endovesical examination is performed, with multiple biopsies, non-tumoral recurrence, and the microscopic examination is negative for malignancy.
The patient is asymptomatic and follows scheduled revisions.
