| A 72-year-old patient with a history of severe cardiovascular disease: ischemic heart disease with myocardial infarction required triple-by-coronary pacemaker and two-year history of atherosclerotic disease, supraaortic canal and lower limb hernia, COPD smoke. | |
| She suffered from lower urinary tract symptoms of one year of evolution, highlighting nocturnal micturition of 4-5 times/night and daytime pollakiuria with two-stage voiding. | |
| Days before the consultation he presented total hematuria with clots. | |
| Physical examination revealed a patient with deterioration of general condition, globulose and abdominal scarring. | |
| The rectal examination revealed a prostate compatible with benign hyperplasia grade II. | |
| Blood tests showed normal blood count, normal renal function, mild hyperuricemia 7.4 and PSA 0.9 ng/ml. | |
| Initial ultrasound showed normal kidneys and exophytic lesion on the right bladder base. | |
| Cytology was positive for malignant cells and cystoscopy confirmed bladder injury. | |
| Analysis of the fragments after TURP showed a mixed papillary carcinoma of smooth muscle transitional cells grade II-III adenocarcinoma with areas mucoid progenitor associated with carcinoma in situ and stage 3 cystic carcinoma pT2-III. | |
| Subsequent CT showed only thickening of the bladder wall and calcified-femoral atheromatosis, the rest of the viscera being normal, without detecting significant lymphadenopathies. | |
| Radical cystoprostatectomy and Camey II ileal neobladder were performed. | |
| The postoperative course was uneventful and the patient was discharged on day 10. | |
| The histological analysis of the specimen revealed an ulcerated epithelial tumor with definitive invasion of the entire thickness of the perivesical adipose wall, consisting of small nests of urothelial cells arranged in vascular lagoons or art | |
| No bodies of psammoma were observed. | |
| There were also associated lesions of epithelial dysplasia in the prostatic urethra and a well differentiated prostate carcinoma in the right lobe Gleason 4 (2+2). | |
| Eleven lymph nodes affected by micropapillary carcinoma were isolated from the left lymphadenectomy specimen while the contralateral lymph nodes were not affected. | |
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| The micropapillary component expressed cytokeratin 7, CA125, cytokeratin 20, BX2 and P53, and was negative for CEA. | |
| A total of 4 cycles of chemotherapy based on gemplatinum plus gencitabine were administered, avoiding cisplatin due to cardiac involvement. | |
| During the treatment she presented several urinary infections and episodes of anemia and leucopenia that required blood transfusions and colony stimulating factors (filgastrim). | |
| After the CMT took several months of acceptable quality of life, the imaging controls by ultrasound and CT at 3, 6 and 9 months showed satisfactory evolution of both kidneys and neobladder. | |
| After 10 months, the patient developed abdominal and bone pain requiring continuous analgesia. | |
| The CT performed one year after surgery showed nodular images suggestive of recurrence in left hemiabdomen and bilateral renoureteral dilation. | |
| The patient died 14 months after diagnosis after progressive deterioration of renal function and general status by intra and retroperitoneal progression. | |