Korean J Urol.  2012 Jan;53(1):63-66. 10.4111/kju.2012.53.1.63.

Skeletal Muscle Metastases from Urothelial Cell Carcinoma

• Doo SW
• Kim WB
• Kim BK
• Yang WJ
• Yoon JH
• Song YS
• Choi IH

• KMID: 1988827
• DOI: http://doi.org/10.4111/kju.2012.53.1.63

Abstract

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.

Keyword

Metastasis; Urothelial cell carcinoma

MeSH Terms

Biopsy
Carcinoma, Transitional Cell
Cystectomy
Cystoscopy
Humans
Muscle, Skeletal
Muscles
Neoplasm Metastasis
Pelvis
Thigh
Urinary Bladder
Urinary Bladder Neoplasms

Figure

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  FIG. 1 Retrograde pyelography (A) and abdominopelvic computed tomography (B) showing the mass at the left renal pelvis.

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  FIG. 2 Thigh MRI (A), whole-body bone scan (B), and PET-CT (C) showing a mass at the left sartorius muscle mass.

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  FIG. 3 Ultrasonography-guided biopsy of the left sartorius muscle consistent with metastatic urothelial carcinoma.

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  FIG. 4 The pathology of the left sartorius muscle biopsy specimen and bladder mass. (A) The needle-biopsied skeletal muscle showed metastatic tumor cells (H&E, ×40).Irregular clusters of poorly differentiated tumor cells infiltrated with desmoplastic are shown. (B) Reaction within the skeletal muscle fiber (H&E, ×100). (C) The tumor cells were polygonal or ovoid shaped and had abundant cytoplasm, irregular hyperchromatic nuclei, and occasional atypical mitoses (H&E, ×400). (D) Transurethral resection of the urinary bladder revealed infiltrative urothelial carcinoma, showing similar cytologic features with the tumor cells in the skeletal muscle (H&E, ×200).

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