ISSN: 2754-8880
Published 00 11 0000
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Edited by
A.Hussain
Submitted 10 Dec. 2022
Accepted 10 Dec. 2022
Citation
Yumnesh J, Satkunan M,
Yan Yw.A Case Report Of A
Rare Presentation Of Breast
Carcinoma Metastases To
The
Bladder.:BJOSS::2022:(3);101-
103
A Case Report Of A Rare Presentation Of
Breast Carcinoma Metastases To The Bladder.
Yumnesh J
1*
, Satkunan M
2
, and Yan Yw
2
1
Department of Surgery, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz,
Jalan Yaacob Latif, Kuala Lumpur, Malaysia
2
Department of Surgery, Hospital Raja Permaisuri Bainun Ipoh, Jalan Raja Ashman Shah, 30450
Ipoh, Perak, Malaysia
*
Corresponding author: E-mail: yumneshj@gmail.com
O R IGI N A L
Abstract
Bladder metastases secondary to breast carcinoma is not uncommon. However, they only account
for 2% of all the reported bladder metastases cases (
1
). Here, we are reporting a patient diagnosed
with breast carcinoma and bladder metastases.
Introduction
Breast cancers rarely metastasize to the brain, adrenal glands, spleen, ovary, peritoneum, pancreas,
kidney, thyroid, heart, and bladder (
2
). Bladder metastases originating from breast cancer are
considered unusual as it only accounts for 2% of all reported bladder metastases cases.
Case Report
A 52-year-old Malay lady with no known co-morbid or family history of carcinoma presented
to us with bilateral breast swelling and right arm lymphoedema. Further examination showed
both breasts were firm and grossly swollen with the erythema. Blood investigations revealed that
the patient had markedly deranged levels of creatinine and urea. Ultrasound of both breasts and
trucut biopsy were done which was reported as triple negative infiltrating ductal carcinoma of the
breasts. Ultrasound imaging of the urinary system was also performed, which surprisingly showed
a bladder mass with bilateral hydronephrosis. Further history did not indicate that patient had any
hesitancy, incontinence, or hematuria. Cystoscopy of the bladder showed a mass at the trigone
occluding both ureteric orifices. Biopsy was taken and a right retrograde pyelogram (RPG) and
stenting, and the left kidney underwent radiologically assisted left percutaneous nephrostomy.
Histopathological diagnosis of the bladder mass biopsy showed it being infiltrating carcinoma.
The malignant cells were positive for CK7 where as CK20 and Calretinin were negative. A staging
Computed Tomography (CT) thorax, abdomen, and pelvis was done once the kidney function
improved. Scans showed bilateral breast carcinoma with metastases to the lung, liver, peritoneum,
and also bladder. In view of her extensive disease, she was offered supportive palliative treatment.
Unfortunately, she passed away within 6 weeks after she was first diagnosed with advanced
breast carcinoma.
Discussion
Bladder metastases are rare. Among the primary tumours that have been reported to metastasize
to the bladder, in descending order of frequency, are gastric cancer, malignant melanoma, breast
cancer, and lung cancer.
Figure 1. Bladder Tumour In Cystoscopy
Figure 2. Bladder Tumour In CT Scan
There are a few theories explaining why breast cancers metastasize to the bladder: 1) the tumour
emboli reach the urinary bladder by hematogenous route (
3
); 2) transcoelomic or retroperitoneal
or dissemination via the lymphatic circulation (
4
); 3) breast carcinoma patients with lymph nodes,
peritoneal and liver involvement have a higher risk of bladder metastasis; 4) immunosuppression
due to steroid therapy causing bladder metastases (
5
). In our case, our patient had extensive
bilateral breast carcinoma, with liver and peritoneal metastases, which most possibly resulted in
bladder involvement as well.
Although bladder metastases are rare, any breast carcinoma patient with urinary symptoms
such as gross or microscopic hematuria, frequency, incomplete voiding, or any renal impairment
should warrant an ultrasound imaging (
6
) of the genitourinary system or cystoscopy examination.
Immunochemistry staining such as cytokeratin, CK-7, CK-20, and CK-18 is useful in the recognition
of epithelial differentiation for breast carcinoma metastases. Specific markers such as estrogen
and progestrogen receptors are useful in identifying breast metastases (
7
). Unfortunately, our
patient’s ER/PR status was negative, therefore no hormonal markers could be tested for the
bladder tumour.
To date, no definitive treatment guideline has been proposed for a case of breast carcinoma
102/103
with bladder metastases. This is because most patients with bladder metastases are associated
with other extensive distant organ metastases. The response of hormonal treatment, systemic
chemotherapy, transurethral resection of bladder tumour, or even radiotherapy is still unknown
in view most of these cases have been reported from post-mortem reviews (
8
). Nevertheless, an
isolated case report showed a patient diagnosed with breast carcinoma and bladder metastases
having stable disease for 22 months after commencing treatment with Tamoxifen (
9
). Poulakis
also reported a patient with breast carcinoma with bladder metastases still surviving 5 years after
chemotherapy and hormonal treatment (
10
). But generally, survival after the onset of distant
metastases is relatively short, which was seen in our patient. The presence of triple negative
receptors also carries a poorer prognosis.
Conclusion
Primary breast cancer with bladder metastases carries a grave prognosis for a patient. Apart from
attempting to cure and control the disease spread, good family counseling with best supportive
palliative care might be the best treatment option for most of these patients and their families.
Conflict Of Interest
All authors declare no conflict of interest of any kind.
References
[1]
Ganem EJ, Batal JT. Secondary malignant tumors of the urinary bladder metastatic from
primary foci in distant organs. The Journal of urology. 1956;75(6):965-72.
[2]
Pontes JES, Oldford JR. Metastatic breast carcinoma to the bladder. The Journal of urology.
1970;104(6):839-42.
[3]
Warren S. Studies on tumor metastasis. The distribution of metastases in cancer of the
breass. Surg Gynecol Obstet. 1933;57:81-5.
[4]
Haid M, Ignatoff J, Khandekar JD, Graham J, Holland J. Urinary bladder metastases from
breast carcinoma. Cancer. 1980;46(1):229-32.
[5]
Sherlock P, Hartmann WH. Adrenal steroids and the pattern of metastases of breast cancer.
Jama. 1962;181(4):313-7.
[6]
Feldman PA, Madeb R, Naroditsky I, Halachmi S, Nativ O. Metastatic breast cancer to the
bladder: a diagnostic challenge and review of the literature. Urology. 2002;59(1):138.
[7]
Shah KG, Modi PR, Rizvi J. Breast carcinoma metastasizing to the urinary bladder and
retroperitoneum presenting as acute renal failure. Indian journal of urology: IJU: journal of
the Urological Society of India. 2011;27(1):135.
[8]
Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma. Analysis of 1000 autopsied
cases. Cancer. 1950;3(1):74-85.
[9]
Soon P, Lynch W, Schwartz P. Breast cancer presenting initially with urinary incontinence: a
case of bladder metastasis from breast cancer. The Breast. 2004;13(1):69-71.
[10]
POULAKIS V, WITZSCH U, de VRIES R, BECHT E. Metastatic breast carcinoma to the
bladder: 5-year followup. The Journal of urology. 2001;165(3):905-5.
103/103
