Department of Urology at Cliniques de l'Europe Site Saint-Michel, Brussels, Belgium;
Rom J Morphol Embryol. 2023 Jan-Mar;64(1):89-94. doi: 10.47162/RJME.64.1.11.
Data shows that bladder cancer (BC) takes the seventh place as the most commonly diagnosed when it comes to the male population. Whereas when both genders considered, it moves down the tenth place. Although 75% of patients with BC present with the disease confined to the mucosa or submucosa, rarely secondary metastasis to the penis occurs.
A 73-year-old male was referred for gross hematuria in May 2018. A cystoscopy was performed detecting a bladder tumor. The resection of the tumor revealed an invasive high-grade (HG) papillary transitional carcinoma of the bladder with nest variants and lamina propria invasion. The histological examination of the second-look resection disclosed the same tumor characteristics. The patient was scheduled for bacillus Calmette-Guérin (BCG) instillations. Meanwhile, he was diagnosed and treated for a primitive lung acinar adenocarcinoma. Seven months after the first diagnosis, the patient progressed to cT4 at the level of the bladder. He underwent four cycles of Methotrexate, Vinblastine, Doxorubicin (Adriamycin) and Cisplatin (MVAC) chemotherapy followed by a cystoprostatectomy. The histological result was fibrosis and ypT0pN0 classification. Due to pain and solid mass in the penis, a total penectomy was performed and the histological result showed a transitional carcinoma suggesting a metastasis of the urothelial carcinoma of the bladder. Three months following the penectomy, a positron emission tomography∕computed tomography (PET∕CT) scan results showed multiple metastases and positive lymph nodes. Hence, Pembrolizumab treatment was started, providing very good clinical and radiological evolution. At the time of publishing, the patient is alive, and the radiological exams show stability of the disease.
The detailed descriptions of all histological variants of carcinoma of the bladder in the specimen has great importance and significant impact on the management of the disease.
数据显示，膀胱癌（BC）在男性中发病率位居第七，而在男女合计中则降至第十位。尽管 75%的 BC 患者的疾病局限于黏膜或黏膜下层，但很少发生继发性阴茎转移。
一名 73 岁男性于 2018 年 5 月因肉眼血尿就诊。行膀胱镜检查发现膀胱肿瘤。肿瘤切除显示为侵袭性高级别（HG）乳头状移行细胞膀胱癌，伴有巢状变异和固有层浸润。再次切除的组织学检查显示出相同的肿瘤特征。患者计划接受卡介苗（BCG）灌注。同时，他被诊断并治疗原发性肺腺泡状腺癌。在首次诊断后 7 个月，患者进展为膀胱水平的 cT4。他接受了 4 个周期的甲氨蝶呤、长春碱、多柔比星（阿霉素）和顺铂（MVAC）化疗，随后进行了膀胱前列腺切除术。组织学结果为纤维化和 ypT0pN0 分类。由于阴茎疼痛和实性肿块，进行了全阴茎切除术，组织学结果显示为移行细胞癌，提示膀胱癌的尿路上皮癌转移。阴茎切除术后 3 个月，行正电子发射断层扫描∕计算机断层扫描（PET∕CT）扫描结果显示多处转移和阳性淋巴结。因此，开始使用 Pembrolizumab 治疗，提供了非常好的临床和影像学疗效。在发表时，患者仍然存活，影像学检查显示疾病稳定。
标本中所有膀胱癌组织学变异的详细描述具有重要意义，并对疾病的管理有重大影响。
