dev/text_files_en/S0210-48062007000700017-1.txt

A 77-year-old male patient (HC 53,296/3), ex-smoker of 60 cigarettes/day, with a history of:
- Adrenal abdominal aneurysm surgery. - Right renal lithiasis.
He consulted for presenting macroscopic monosymptomatic hematuria in 1999.
He was diagnosed with transitional bladder carcinoma showing very focal areas micropap (G3-pT1) and areas of carcinoma in situ.
1.
Later he had tumor recurrence in 2000 and 2004 diagnosed with carcinoma in situ and were treated with intravesical chemotherapy (BCG).
In January 2005, the patient came to our hospital because of a tumor in the abdominal wall at the level of the right iliac fossa. For this reason, a CT scan (computed tomography) of the abdominal wall of 6 cm showed a solid mass.
Laparotomy was performed with en bloc resection of the abdominal wall.
An irregular fragment weighing 180 g and a mean of 9 x 9 x 7 cm was received at the Pathological Anatomy Service. Serial sections identified a whitish nodular lesion with a firm edge that was close to 6 x 6 cm.
The anatomopathological study showed a poorly differentiated carcinoma of high histological grade that frequently showed a micropapillary pattern and frequent permeation of lymphatic vessels, suggesting its metastatic origin.
Immunohistochemical studies showed positivity for keratin (AE1-AE3) and cytokeratin (CK) 7 and negativity for CK20, TTF-1, N-Cam, Cromofiline
The final diagnosis was abdominal wall metastasis from a micropapillary bladder carcinoma.
1.
Subsequently, PET (Postytron emission tomography) was performed on the right hemipelvis, on the iliac path, a focal hypermetabolic deposit compatible with lymph node metastasis CT scan confirmed later in the diagnosis.
However, no bladder recurrence was detected and urine cytology was negative.
Four cycles of chemotherapy were administered according to the Carboplatin-Gemcitabine protocol, aiming at a complete response in the review.
The patient is alive and disease-free 12 months after the initial diagnosis.