A 41-year-old male with a history of allergy to penicillins, hypertension under medical treatment, and psoriasis presented to our clinic for hematuria.
Urine cytology was performed with atypia suggestive of malignancy and abdominal ultrasound showed a mass in the left lateral face 65x46 mm producing a bladder voiding necrosis.
These findings are subjected to TUR of the bladder, resecting a mass with an appearance that occupies the entire lateral left side and does not let the ureteral orifice be seen.
A left nephrostomy is also placed.
The pathology of this mass was infitrating undifferentiated urothelial carcinoma of the bladder.
Accompanying the above mentioned clinical picture, a CT scan revealed normal abdominal CAT scan, normal skin gammagraphy, retrograde bone scintigraphy revealed a mass in the uretheral lumen that was not visible within the ureteral lumen
Since the extension study was negative, a Bricker-type radical cystoprostatectomy was performed.
The pathology was a high grade solid urothelial carcinoma that included perivesical fat, prostate and urethra with tumor-free surgical margins.
They are visualized in peritumor vessels located in the vascular lumen.
Left iliobturator chain lymph nodes infiltrated by urothelial carcinoma (pT4aN1M0).
In the postoperative period, the patient presented recurrent episodes of anemia and thrombopenia that did not improve despite transfusions and platelets.
Renal function normal and bricker functioning was correct from the beginning.
After 5 days the patient was successfully tolerated.
Active tuberculosis ruled out anemia (about 7 gr/dl of hemoglobin) and thromboptypia around 2 gr/ml of platelets isolated at first bleeding was not observed.
Enoxaparin was removed to avoid pharmacological causes of thrombopenia.
Coagulation was always normal and there were no signs of bleeding, discarding disseminated intravascular coagulation (DIC).
Hemolytic symptoms were also ruled out as bilirubin was normal and direct Coombs test was negative.
Since the cause of recurrent episodes of anemia and thrombopenia was not found, aspiration puncture of bone marrow was performed, obtaining metastatic cells from urothelial carcinoma.
When discovering the bone marrow inadequate due to the bladder tumor, a subitutive hemotherapy treatment was performed and chemotherapy was initiated, the patient died 3 weeks later.
