A 60-year-old man with a history of recurrent urinary tract infections came to the emergency department complaining of a mass in the lower abdominal area of about six months of evolution, which bleeds spontaneously.
During physical examination, a bladder exstrophy plate was observed in the hypogastrium and a complete epispadic penis, which were not surgically corrected during childhood.
An exophytic formation of 10 cm in diameter and hard consistency within the plaque stood out, with a friable surface bleeding at the minimum friction.
No inguinal lymphadenopathies were detected and the rest of the exploration did not yield other findings.
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Blood analysis showed a creatinine level of 2.2 mg/dL and the rest of the parameters were normal.
After hospital admission for study, a bilateral renal ultrasound was performed in which a grade III/IV dilatation of both foot-and-mouth disease systems was observed.
Intravenous urography showed functional annulation of the right kidney, with delayed elimination of the left kidney.
The bladder adenocarcinoma mass was biopsied.
Contrast-enhanced CT scan and pelvic CT scan showed no evidence of metastasis.
The patient underwent surgery, performing a radical cystoprostatectomy with lymphadenectomy plus Indiana type derivation and closure of the abdominal wall defect with fascia lata.
Histopathological analysis of the surgical piece revealed an intestinal adenocarcinoma with some signet ring cells.
The margins of the specimen were infiltrated, with extensive soft tissue and peritoneum involvement and two iliac adenopathies were isolated due to the tumor.
Tumor stage corresponded to T4bN2M0.
On the contrary, physicians treating patients with dementia should consider that this would not increase patient survival.
At 6 months follow-up after surgery, left inguinal lymphadenopathy was confirmed, painless and of increased consistency, along with induration of the edges of the surgical wound, finding compatible with local recurrence of the tumor.
Bone screening at this time continued to be negative and CT showed a heterogeneous mass with poorly defined borders in the surgical bed.
The patient died 2 months later due to urinary sepsis.
