Chamas Hassan, Hoffmann Brian, Millard Jonathan
Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
General and Colorectal Surgery, Carilion Clinic, Christiansburg, USA.
Cureus. 2025 Feb 21;17(2):e79416. doi: 10.7759/cureus.79416. eCollection 2025 Feb.
Urothelial carcinoma arises from the urothelial cells that line the urinary tract, which extends from the renal pelvis to the urethra. Bladder cancer commonly metastasizes to the lymph nodes, bones, liver, and lungs. In rare cases, such as in this case report, it can metastasize to the rectum. In this case report, a 62-year-old male patient presented initially with constipation, anal discharge, perineal pain, mild difficulty urinating, and a rectal mass. The first CT abdomen and pelvis with IV contrast revealed the rectum, sigmoid colon, and proximal descending colon to have circumferential wall thickening with retroperitoneal enlarged lymph nodes. An MRI pelvis with and without contrast revealed marked concentric mass-like wall thickening of the entire rectum, with extensive mesorectal and pelvic lymphadenopathy. A second CT pelvis with IV contrast again revealed extensive rectal wall thickening and irregular thickening of the bladder wall. Rectal endoscopic ultrasound (EUS) with biopsy was performed and found the rectal mass to be high-grade metastatic urothelial carcinoma. Transurethral resection of bladder tumor (TURBT) found high-grade urothelial carcinoma involving the bladder trigone. This case provides a unique observation of a patient whose presenting symptoms were due to metastatic disease and who did not begin suffering major urinary symptoms suggesting bladder cancer until later in the course of the disease. It is important for the differential of a rectal mass to include the possibility of it being a rectal metastasis even if the patient only presents with rectal symptoms initially.
尿路上皮癌起源于尿路衬里的尿路上皮细胞，尿路从肾盂延伸至尿道。膀胱癌通常转移至淋巴结、骨骼、肝脏和肺部。在罕见情况下，如本病例报告所示，它可转移至直肠。在本病例报告中，一名62岁男性患者最初表现为便秘、肛门排出物、会阴疼痛、轻度排尿困难和直肠肿块。首次腹部和盆腔增强CT显示直肠、乙状结肠和降结肠近端有环形壁增厚及腹膜后肿大淋巴结。有对比剂和无对比剂的盆腔MRI显示整个直肠有明显的同心性肿块样壁增厚，伴有广泛的直肠系膜和盆腔淋巴结病。第二次盆腔增强CT再次显示直肠壁广泛增厚及膀胱壁不规则增厚。进行了直肠内镜超声检查（EUS）并活检，发现直肠肿块为高级别转移性尿路上皮癌。经尿道膀胱肿瘤切除术（TURBT）发现高级别尿路上皮癌累及膀胱三角区。本病例提供了一个独特的观察结果，即患者的首发症状是由转移性疾病引起的，且直到疾病后期才开始出现提示膀胱癌的主要泌尿系统症状。即使患者最初仅表现为直肠症状，在鉴别直肠肿块时将其可能为直肠转移瘤纳入考虑范围也很重要。
