Isolated cerebellar metastasis from urothelial carcinoma: a case report of a rare phenomenon

doi:10.21203/rs.3.rs-1986367/v1

Download PDF

Research Article

Isolated cerebellar metastasis from urothelial carcinoma: a case report of a rare phenomenon

https://doi.org/10.21203/rs.3.rs-1986367/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 01 Jan, 2023

Read the published version in Brain and Spine →

Version 1

posted

You are reading this latest preprint version

Introduction

Although urothelial carcinoma (UC) generally is non-invasive, contrastingly in 25% of patients UC metastasizes. Isolated CNS metastasis from UC without other distant metastases are considered rare. In this case report we describe a patient with an isolated and solitary cerebellar metastasis from UC.

Case presentation

A 77-year-old male was diagnosed with a pT2N0M0 high-grade urothelial carcinoma and treated with transurethral resection and chemoradiation therapy. Several months later, the patient presented with neurological symptoms, and radiological imaging revealed a solitary cerebellar mass. A body CT scan showed no other metastasis. After surgical resection, histology confirmed a urothelial origin of the mass, matching his primary UC and the patient received post-operative stereotactic radiotherapy at the surgical site.

Conclusions

Isolated brain metastases without other distant metastases from UC are rare, so histologic confirmation of the brain metastasis is essential, particularly when the time interval between diagnosis of the UC and brain metastasis increases.

Case report

Urothelial carcinoma

Metastasis

Central nervous system

Surgery

Radiotherapy

Urothelial carcinoma (UC) is the most common type of lower urinary tract cancer comprising approximately 90% of all bladder tumours [1]. The annual incidence is estimated to be 393.000 patients worldwide with 5500 cases per year in the Netherlands. The incidence increases with age and the majority of patients are above 65 years old. Several risk factors have been identified for development of UC including smoking, exposure to carcinogenic agents, chronic cystitis, HPV infection and a history of radiotherapy or cyclophosphamide treatment [2–5]. Although most UCs (non-muscle invasive bladder cancer; NMBC) are limited to the mucosa or submucosa, approximately 25% progress to muscle invasive bladder cancer and metastasize [6].

Metastases from UC are predominantly found in peri-vesical lymph nodes (70%), bones (49%), lungs (35%) and liver (27%) [7]. Central nervous system (CNS) metastases from UC are rare. Most CNS metastases originate from lung-, breast-, colon-, or kidney cancer, or melanoma [8]. Since brain metastases with urothelial origin occur very rarely routine imaging for metastatic spread covers the thoracic and abdominal cavities but not the cranial region and, therefore, these metastases are usually only detected after the patient presents with neurological symptoms. Furthermore, CNS metastasis from UC without other distant metastases occurs even less frequently and the number of published papers covering this phenomenon is in a total of 36 patients [9–36]. In this case report we present a patient with an isolated cerebellar metastasis and no signs of extracranial disease activity, originating from his primary UC.

Clinical presentation

A 77-year-old male presented at the emergency department in August 2020 with complaints of haematuria since several hours. He had a medical history of chronic renal disease diagnosed in December 2019 that was preceded by an episode of macroscopic haematuria with urinary retention for which he was catheterized. The patient had not recently experienced any urinary tract infections nor used any anticoagulant medication. Upon presentation at the emergency department, first the bladder was irrigated to clear urine and the patient was discharged upon further outpatient examinations.

Two weeks later CT Intravenous Pyelography (CT IVP) was performed which demonstrated a diffusely irregularly thickened wall of the bladder on the cranioventral side. Cystoscopy revealed no evident irregularities at that time. Transurethral resection of the suspected lesion of the bladder wall was performed and pathological analysis revealed a urothelial carcinoma reaching into the musculus detrusor layer. Additional CT imaging of the thoracic and abdominal regions did not demonstrate any further metastases; therefore, the tumour was classified as a pT2N0M0 high grade carcinoma.

Although surgical treatment through radical cystectomy with Bricker ileal conduit was considered possible, the patient opted for chemoradiation therapy as advised during a multidisciplinary consultation meeting due to his impaired renal function. The patient underwent radiotherapy with an elective nodal dose of 50 Gy and 63.25 Gy aimed at the primary tumour divided over five fractions per week for the duration of five weeks. Concurrently, the patient started chemotherapy through a single treatment with mitomycin and daily dose of capecitabine during the same five weeks. At four months follow-up, CT thorax, abdomen and cystoscopy revealed complete response and no metastases.

Ten months after the primary diagnosis, the patient presented at the emergency department with neck pain radiating towards the left side of his head. He had vomited and required support during walking due to ataxia. The patient was admitted for further diagnostic work-up.

Imaging

A CT and MRI scan of the brain showed a solitary 29 mm in diameter cerebellar mass in the right hemisphere with some hypodensities indicating partial necrosis of the lesion. Furthermore, as a result of tumour oedema a slight midline shifting causing compression of the brain stem and fourth ventricle was observed (Figs. 1 and 2). Repeated thoracic and abdominal CT imaging did not demonstrate any other primary malignancy nor metastatic lesions of the primary tumour.

Therapeutic approach

Upon neurosurgical consultation, the cerebellar mass was surgically removed through a lateral suboccipital craniotomy. During surgery, the cerebellum appeared swollen, and after complete resection of the tumour, sufficient relaxation of the brain was achieved. Postoperative, dexamethasone could be stopped completely, and the patient was discharged two days after surgery from the hospital.

Histological findings

During surgery, the samples had a brown-grey appearance with a lamellar structure, partially haemorrhagic. Histological analysis revealed an epithelial tumour featuring irregularly enlarged and partially polymorphous nuclei and substantial cytoplasm. Immunohistochemistry revealed that the tumour cells were positive for keratin 5/6, keratin 7, keratin 20, keratin 34 beta E12 and GATA-3. All histological findings matched the report of the primary urothelial origin (Fig. 3a and 3b).

Post-operative follow-up

After treatment, the patient fully recovered and regained full physical functionality. Follow-up MRI examination one day after surgery showed a complete resection and the patient was referred for post-operative stereotactic radiotherapy. A single dose of 18 Gy was administered to the resection cavity and surrounding cerebellar tissue.

Repeat cystoscopy 12 and 18 months after initial presentation with haematuria demonstrated no signs of recurrence of UC in the bladder. Additionally, at 18 months follow-up the patient underwent CT examination of the thoracic and abdominal regions which demonstrated no metastatic activity in the body. However, six months after brain surgery the patient showed recurrent signs of ataxia and repeated MRI of the brain demonstrated contrast enhancement without increased perfusion most probably due to radiation necrosis. However, follow-up MRI six weeks later showed growth of the lesion with signs of supratentorial hydrocephalus indicating recurrence of metastasis. Consequently, the patient underwent re-resection of the lesion and histological analysis confirmed metastatic recurrence with partially vital and partially necrotic tumorous tissue. An MRI scan one day after surgery showed minimal contrast enhancement which will be followed up. The patient was referred for a second session of post-operative stereotactic radiotherapy and is currently recovering well.

Brain metastases account for 13–39% of all intracranial malignancies and are often detected at a late stage of systemic malignancy [37–39]. The majority of brain metastases is located in the supratentorial region, however 15% is found in the cerebellar hemispheres [40]. In general, the prognosis after brain metastasis is poor and among other depends on the type of primary malignancy with an overall median survival of 13 months [41]. Brain metastases usually originate from primary tumours in the lungs (19.9%), skin (6.9%), kidneys (6.5%), breasts (5.1%) and gastrointestinal tract (1.9%) [8]. In this case report we present a patient with a solitary metastasis of his primary UC.

Isolated brain metastases (i.e., without other distant metastases) from UC are rare. UC tends to metastasize first to thoracic or abdominal structures and from these sites to the central nervous system in up to 7% of patients with bladder cancer [12]. However, the incidence of CNS metastases from urothelial origin has been increasing over the years. In general, with the introduction of targeted therapies and immunotherapies, the survival of patients with cancer has prolonged, and more CNS metastases in this course are observed [42]. Moreover, improvements in radiological imaging techniques, may have resulted in a further increase of CNS metastases detection. Furthermore, chemotherapy remains the standard treatment strategy for distant metastases of UC, however, its inability to pass the blood brain barrier could make it less effective for CNS metastases resulting in an increasing incidence of these lesions [16].

Only a limited number of case reports and case series has been published on histologically-confirmed isolated CNS metastasis without other distant metastases from UC in a total of 36 patients [9–36] (Table 1). In general, these CNS metastases are only identified when the patient presents with neurological symptoms, as routine MRI scans of the brain are usually not done in UC patients. In literature, the median time to detection of isolated CNS metastasis after UC diagnosis is 6 months (range 0–42 months) [9, 10, 12–20, 22–31, 33–36]. Several other articles describe CNS metastasis from UC, but in these reports extracranial metastases preceded or were concurrently identified with CNS metastasis, or the urothelial origin of the CNS metastasis was not confirmed by histological analysis [43–47]. Without histological confirmation clinicians should consider other differential diagnoses including a primary CNS tumour or metastasis from another primary site than UC [48].

Table 1

overview of literature on isolated, histologically confirmed CNS metastasis from UC without other distant metastases
Authors, year (reference)	Article type	Number of patients	Gender / age	Stage primary tumour	CNS location	Solitary/multiple metastases	Interval between primary and metastasis	Neurologic deficits	Treatment	Survival
Anderson et al., 1992 [9]	Case series	3	M 62	D2	Brain	Solitary	Concurrent	-	Resection + radiotherapy	14 mo
			M 54	C	Brain	Solitary	23 mo	-	Resection + radiotherapy	5 yr
			M 62	C	Brain	Solitary	42 mo	-	Resection + radiotherapy	9 mo
Bruna et al., 2003 [10]	Case report	1	M 66	pT3_aN_xM1	Leptomeningeal	-	Concurrent	Seizures	Intrathecal chemotherapy	2 mo
Butchart et al., 2010 [11]	Case report	1	M 58	T2N1M0	Leptomeningeal	-	> 5 mo	Headache, ataxia, vomiting	-	1 mo
Clatterbuck et al, 1998 [12]	Case report	1	M 72	Stage I	Cerebral, left	Solitary	Concurrent	Right homonymous hemianopsia, Gerstmann’s syndrome	Decadron, resection, chemotherapy, WBRT	11 mo
Cozzarini et al., 1999 [13]	Case series	1	M 40	pT3G3pN0	Leptomeningeal	-	10 mo	Headache, lethargy, confusion, 7th cranial nerve palsy, impaired vision, weakness of right extremities	Intrathecal methotrexate	> 1 wk
Crowley et al., 2008 [14]	Case report	1	M 74	High-grade invading the perivesicular tissue	Intramedullary, T1-T2	Solitary	6 mo	Brown-Séquard syndrome	Subtotal resection, external beam radiation therapy	2 mo
D’Souza et al., 2011 [15]	Case report	1	F 69	G3pT1	Cerebellar, right hemisphere	Solitary	11 mo	Slurred speech, left-sided facial drooping, left eye visual disturbance, ataxia, nausea, confusion, headache	Resection, WBRT	> 21 mo
Davies et al., 2003 [16]	Case report	1	M 56	T1	Cerebellar, right hemisphere	Solitary	Concurrent	Headache, ataxia	Resection, stereotactic radiotherapy, chemotherapy	-
Davis et al., 1986 [17]	Case report	1	M 54	Grade III, stage B2	Cerebral, left	Solitary	5 mo	Focal seizures, lethargy, disorientation, aphasia	Dexamethasone, phenytoin, WBRT, resection, chemotherapy	> 18 mo
Diamantopoulos et al., 2021 [18]	Retrospective cohort	1	? 45	T2	Cerebral	Multiple	11.8 mo	-	WBRT, resection	6 mo
Erhamamci et al., 2014 [19]	Case report	1	M 45	T2N0	Cerebral	Multiple	11 mo	Nausea, dizziness, loss of balance	Excisional biopsy, whole brain radiotherapy	16 mo
Findler et al., 1983 [20]	Case report	1	M 67	-	Cerebral, right hemisphere	Solitary	2 yr	Sudden onset of confabulation, confusion, and memory loss	Biopsy + radiotherapy	-
Gardner et al., 2013 [21]	Case report	1	M 74	Grade IV, T4bN2M0	Cerebellar, left vermis	Solitary	> 11 mo	Unstable gait, fatigue, dizziness, disequilibrium, diplopia	Resection, WBRT	> 9 mo
Girgis et al., 1999 [22]	Case report	1	M 72	-	Cerebral, right hemisphere	Solitary	5 mo	Changed behaviour, left facial drooping, diminished motor skills	Resection	9 mo
Hayashi et al., 2011 [23]	Case series	1	M 76	pT1N0M1	Cerebral, left parietal	Solitary	Concurrent	Dysphasia	Resection	> 8 yr
Kabalin et al., 1988 [24]	Case series	2	F 62	Grade III/IV	Cerebellar, right hemisphere	Solitary	12 mo	Nausea, vomiting, confusion	None	Postmortem
			M74	Grade III/IV	Cerebellar, left hemisphere	Solitary	4 mo	Nausea, vertigo, headaches	Resection	2 mo
Kartha et al., 2015 [25]	Case report	1	M 59	Grade III	Cerebellar, right vermis	Solitary	Concurrent	Increasing headache	Resection + WBRT	11 yr
Kuppa et al., 2021 [26]	Case report	1	M 58	ypT0	Left cerebellum, right frontal	Multiple	15 mo	Nausea, vomiting, dizziness, weakness and urinary incontinence	Resection (cerebellum) + SRS (cerebral laesions) + radiation therapy + immunotherapy	> 23 mo
Leadbetter et al., 1937 [27]	Case report	1	M 47	Grade IV	Cerebral, left frontal	Solitary	3 mo	Weakness/unsteadiness right leg, headaches, partial visual impairment, vomiting, drowsiness	Resection	0 d^a
Mahmoud-Ahmed et al., 2002 [28]	Case series	1	F 69	T4aN1M0	Cerebral, frontal	Multiple	0.5 mo	Seizures	Resection	1.25 mo
Majcherczyk et al., 2021 [29]	Case report	1	M 55	T2 high-grade	Cerebellum, both hemispheres	Solitary	Concurrent	Headache, dizziness, unilateral ataxia	Antiedema treatment, resection, radiotherapy, chemotherapy	-
Qasho et al., 1999 [30]	Case report	1	M 40	Bladder wall laesion	Choroid plexus right lateral plexus	Solitary	Concurrent	Seizures, temporo-spatial disorientation, impairment of long-term memory	Resection	-
Salvati et al., 1993 [31]	Case series	6	M 55	b2/III	Cerebral, right frontal	Solitary	5.1 mo	Intracranial hypertension	Surgery + WBRT	9.2 mo
			F 57	c/II	Cerebral, right temporal	Solitary	8.1 mo	Inracranial hypertension, seizures	Surgery + WBRT	6 mo
			M 63	d1/III	Cerebral, left frontal	Solitary	3.1 mo	Intracranial hypertension	Surgery + WBRT	4 mo
			F 71	b2/II	Cerebral, right frontal	Solitary	7.1 mo	Intracranial hypertension, seizures	Surgery + WBRT	7.1 mo
			M 72	c/III	Cerebral, left temporal	Solitary	6 mo	Intracranial hypertension	Surgery + WBRT	9.8 mo
			M 72	c/III	Cerebral, right parietal	Solitary	6 mo	Intracranial hypertension	Surgery + WBRT	7.9 mo
Santarossa et al., 1997 [32]	Case report	1	F 52	T4-N3-M0	Leptomeningeal	-	> 8 mo	Headache, loss of memory, confusion, left hemiplegia, episodic seizures	Intrathecal methotrexate + dexamethasone, WBRT	9 mo
Shamdas et al., 1992 [33]	Case report	1	F 84	Grade II TCC with invasion of the smooth muscle wall	Cerebellar, right hemisphere	Solitary	5 mo	Progressive ataxic gait, finger-to-nose and heel-to-knee impairment on right side, acute onset of occipital headaches, mild impairment of recent memory, horizontal nystagmus	Dexamethasone + resection + postoperative external beam radiation	-
Stastny et al., 1996 [34]	Case series	1	F 60	TCC invading the underlying muscularis	Leptomeningeal	-	17 mo	Persistent headaches	Ommaya reservoir, intrathecal methotrexate, cranial radiation therapy	-
Worm et al., 2016 [35]	Case report	1	F 72	-	Cerebellar, vermis	Solitary	2 yr	Headache, dizziness, loss of balance, dysmetria, dysdiadochokinesia	Resection, ventricle-peritoneal bypass	20 mo
Zennami et al., 2008 [36]	Case report	1	M 65	pT1, G3	Cerebral, left parietal	Solitary	34 mo	Headache, homonymous right hemianopia	Surgery	2.6 mo
^a Patient died intraoperatively

Survival of UC CNS metastasis ranges from several days to more than 10 years with most studies reporting a median survival of less than one year depending on the type of treatment (local, systemic or combination) and strongly declines in patients without any intervention [28, 49–52]. However, the majority of patients included in these studies had multiple CNS metastases and/or simultaneously suffered from extracranial disease activity. Currently, treatment paradigms for newly diagnosed brain metastases involve surgical resection, stereotactic radiosurgery (SRS), whole-brain radiotherapy (WBRT) and/or systemic therapy [53] and should be decided on an individual patient basis in a multidisciplinary setting. For brain metastases from UC, a small retrospective study showed that a combination of surgery and post-operative radiotherapy results in better survival than radiation therapy alone (mean survival time, respectively, 19 and 6 months), although the latter group included patients with multiple CNS metastases [52]. Furthermore, two randomized-controlled trials have demonstrated that surgery combined with radiotherapy resulted in longer survival, less disease recurrence and superior quality of life compared to radiation therapy only [54, 55]. Nevertheless, the patients in these trials suffered from CNS metastases not exclusively originating from UC. Despite the ongoing development in therapeutic options, brain metastases recur in up to 50% of surviving patients within 6 to 12 months after initial treatment which is also shown in this case report [56].

Several ways of hematogenous spread have been proposed to explain the presence of isolated brain metastasis from UC in our patient. Tumour cells could enter the venous system and directly reach the arterial blood circulation and, subsequently, the cerebellum: (1) via the pulmonary capillaries, or (2) through a paradoxical tumour embolus via a patent foramen ovale. In addition, metastatic distribution by a retrograde venous route via the paravertebral venous plexus allows for direct flow from the venous system towards the cerebellum [57–60]. The blood vessels of the venous circulation in the pelvic area that communicate with the vertebral venous plexus lack valves which makes bidirectional flow possible. Through this mechanism tumour cells could directly reach the cranial veins via the vertebral venous plexus. Finally, it should be considered that the isolated cerebellar metastasis in our patient is secondary to a pulmonary or other metastasis which were not detectable on radiological imaging, or the systemic chemotherapy treated the primary and systemic metastatic lesions but not the brain metastasis due to the blood brain barrier. Therefore, repeat CT imaging of the thoracic and abdominal regions may not reveal any primary distant metastases in this case after treatment, although pre-treatment imaging did not demonstrate any systemic metastases either.

Particularly in rare cases with an isolated CNS metastasis without other metastatic sites, examination through PET may have additional value in detecting distant metastases from UC that were not discovered on CT imaging and, therefore, affect treatment strategy. Several studies have reported sensitivities between 50–100% and specificities of 86–100% for FDG PET/CT to detect metastases outside the pelvic area [61]. Moreover, in two studies FDG PET/CT was shown to be superior to conventional CT staging with sensitivities of 54% and 74.9% vs. 41% and 43.7%, respectively [62, 63]. Findings from FDG PET/CT may influence treatment strategy in up to 68% of patients [64, 65]. In addition, FDG PET/CT may be useful in detection of recurrent muscle-invasive UC [61].

In this case report a rare case of cerebellar metastasis originating from UC is described in detail. Several hypotheses have been proposed that may explain the absence of other distant metastases and the interventions performed in this patient are carefully evaluated. Furthermore, a comprehensive overview of literature is provided covering cases with CNS metastasis from UC based on histological confirmation. However, this case report is limited by the paucity of literature on this patient group and trials assessing therapies for patients with CNS metastasis from UC.

Isolated cerebellar metastasis from urothelial carcinoma without other distant metastases is a rare phenomenon with an uncertain route of metastatic distribution. Therefore, histologic confirmation is essential to confirm the type of primary tumour, particularly when there is a longer time interval between detection of the primary tumour and brain metastasis. Although survival after UC is improving, the prognosis of this disease with intracranial metastasis remains poor. For our patient, treatment of UC appears to have been successful at 18 months follow-up. However, due to the symptomatic recurrence of the cerebellar metastasis the prognosis in this patient is unfavourable.

Acknowledgments

Not applicable

Funding

No funding was received for this manuscript

Conflicts of interest

The authors declare no conflicts of interest.

Ethics approval

Not applicable

Consent to participate

Not applicable

Written consent for publication

Consent for publication was received from the patient described in the manuscript by his treating physician.

Availability of data and material

Not applicable

Code availability

Not applicable

Authors’ contributions

All authors were involved in the treatment of the patient, analysis and interpretation of diagnostic data described in this manuscript. EJAV and HR drafted the manuscript. HR, WT, RNT and MCAG revised the manuscript. All authors have approved the current form of this manuscript for submission.

Wong MCS, Fung FDH, Leung C, Cheung WWL, Goggins WB, Ng CF. The global epidemiology of bladder cancer: a joinpoint regression analysis of its incidence and mortality trends and projection. Sci Rep. 2018;8(1):1129. doi:10.1038/s41598-018-19199-z. PubMed PMID: 29348548; PMCID: PMC5773684. Epub 2018/01/20.
Ebrahimi H, Amini E, Pishgar F, et al. Global, Regional and National Burden of Bladder Cancer, 1990 to 2016: Results from the GBD Study 2016. J Urol. 2019;201(5):893–901. doi:10.1097/ju.0000000000000025. PubMed PMID: 30676477. Epub 2019/01/25.
Burger M, Catto JW, Dalbagni G, et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2013;63(2):234–41. doi:10.1016/j.eururo.2012.07.033. PubMed PMID: 22877502. Epub 2012/08/11.
Daneshmand S. Epidemiology and risk factors of urothelial (transitional cell) carcinoma of the bladder. In: Bellmunt J, Shah S, editors. UpToDate. Waltham: Wolters Kluwer; 2021.
Bellmunt J. Treatment of metastatic urothelial cancer of the bladder and urinary tract. In: Lerner SP, Shah S, editors. UpToDate. Waltham: Wolters Kluwer; 2021.
Shinagare AB, Ramaiya NH, Jagannathan JP, Fennessy FM, Taplin ME, Van den Abbeele AD. Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol. 2011;196(1):117–22. doi:10.2214/ajr.10.5036. PubMed PMID: 21178055. Epub 2010/12/24.
Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22(14):2865–72. doi:10.1200/jco.2004.12.149. PubMed PMID: 15254054. Epub 2004/07/16.
Anderson RS, el-Mahdi AM, Kuban DA, Higgins EM. Brain metastases from transitional cell carcinoma of urinary bladder. Urology. 1992;39(1):17–20. Epub 1992/01/01. doi: 10.1016/0090-4295(92)90034-t. PubMed PMID: 1728790.
Bruna J, Rojas-Marcos I, Martínez-Yelamos S, et al. Meningeal carcinomatosis as the first manifestation of a transitional cell carcinoma of the bladder. J Neurooncol. 2003;63(1):63–7. doi:10.1023/a:1023781604980. PubMed PMID: 12814256.
Butchart C, Dahle-Smith A, Bissett D, Mackenzie JM, Williams DJ. Isolated Meningeal Recurrence of Transitional Cell Carcinoma of the Bladder. Case Rep Oncol. 2010;3(2):171–5. Epub 20100608. doi: 10.1159/000315473. PubMed PMID: 20740192; PMCID: PMC2919995.
Clatterbuck RE, Sampath P, Olivi A. Transitional cell carcinoma presenting as a solitary brain lesion: a case report and review of the world literature. J Neurooncol. 1998;39(1):91–4. doi:10.1023/a:1005918508317. PubMed PMID: 9760074. Epub 1998/10/06.
Cozzarini C, Reni M, Mangili F, Baldoli MC, Galli L, Bolognesi A. Meningeal carcinomatosis from transitional cell carcinoma of the bladder: report of two cases and review of the literature. Cancer Invest. 1999;17(6):402–7. doi: 10.3109/07357909909021432. PubMed PMID: 10434951.
Crowley RW, Sherman JH, Le BH, Jane JA, Sr. Intramedullary spinal cord metastasis from bladder carcinoma: case report. Neurosurgery. 2008;63(3):E611-2; discussion E2. doi: 10.1227/01.Neu.0000324898.69073.E1. PubMed PMID: 18812942.
D'Souza N, Khan MJ, Robinson S, Motiwala H. A rare and unusual case of isolated cerebellar metastasis from a non-muscle invasive transitional cell carcinoma of bladder. JRSM Short Rep. 2011;2(6):50. doi:10.1258/shorts.2011.011014. PubMed PMID: 21731820; PMCID: PMC3127493. Epub 2011/07/07.
Davies BJ, Bastacky S, Chung SY. Large cerebellar lesion as original manifestation of transitional cell carcinoma of the bladder. Urology. 2003;62(4):749. doi:10.1016/s0090-4295(03)00662-9. PubMed PMID: 14550465. Epub 2003/10/11.
Davis RP, Spigelman MK, Zappulla RA, Sacher M, Strauchen JA. Isolated central nervous system metastasis from transitional cell carcinoma of the bladder: report of a case and review of the literature. Neurosurgery. 1986;18(5):622–4. doi:10.1227/00006123-198605000-00018. PubMed PMID: 3714011. Epub 1986/05/01.
Diamantopoulos LN, Khaki AR, Sonpavde GP, et al. Central Nervous System Metastasis in Patients With Urothelial Carcinoma: Institutional Experience and a Comprehensive Review of the Literature. Clin Genitourin Cancer. 2020;18(3):e266-e76. doi: 10.1016/j.clgc.2019.11.008. PubMed PMID: 32178979; PMCID: PMC7272305.
Erhamamcı S, Reyhan M, Altinkaya N. A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder. Rev Esp Med Nucl Imagen Mol. 2014;33(5):290–2. doi:10.1016/j.remn.2013.10.008. PubMed PMID: 25043771. Epub 2014/07/22.
Findler G, Feinsod M, Lijovetzky G, Hadani M. Transient global amnesia associated with a single metastasis in the non-dominant hemisphere. Case report. J Neurosurg. 1983;58(2):303–5. doi:10.3171/jns.1983.58.2.0303. PubMed PMID: 6848697.
Gardner FPTW. Ataxia in a Patient With Urothelial Carcinoma: Pathologic Confirmation, Recovery, and Improved Survival. Clinical Advances in Hematology & Oncology. 2013;11(7).
Girgis S, Ramzy I, Baer SC, Schwartz MR. Fine needle aspiration diagnosis of transitional cell carcinoma metastatic to the brain. A case report. Acta Cytol. 1999;43(2):235–8. Epub 1999/03/31. doi: 10.1159/000330984. PubMed PMID: 10097716.
Hayashi T, Tanigawa G, Fujita K, et al. Two cases of plasmacytoid variant of urothelial carcinoma of urinary bladder: systemic chemotherapy might be of benefit. Int J Clin Oncol. 2011;16(6):759–62. doi:10.1007/s10147-011-0240-4. PubMed PMID: 21732230. Epub 20110707.
Kabalin JN, Freiha FS, Torti FM. Brain metastases from transitional cell carcinoma of the bladder. J Urol. 1988;140(4):820-4. Epub 1988/10/01. doi: 10.1016/s0022-5347(17)41826-x. PubMed PMID: 3418810.
Kartha GK, Sanfrancesco J, Udoji E, Chaparala H, Hansel D, Jones JS. Long-term Survival From Muscleinvasive Bladder Cancer With Initial Presentation of Symptomatic Cerebellar Lesion: The Role of Selective Surgical Extirpation of the Primary and Metastatic Lesion. Rev Urol. 2015;17(2):106–9. doi:10.3909/riu0643. PubMed PMID: 27222649; PMCID: PMC4857904.
Kuppa S, Wei J, Strother M, Miyamoto C, Weaver M, Kutikov A. Multiple brain metastases in a patient with ypT0N0 micropapillary urothelial carcinoma of the bladder. Urol Case Rep. 2021;39:101838. doi:10.1016/j.eucr.2021.101838. PubMed PMID: 34631426; PMCID: PMC8488483. Epub 20210913.
Leadbetter WF, Colston JAC. Brain Metastasis in Carcinoma of the Bladder < sup > 1. J Urol. 1937;38(3):267–77. doi:10.1016/S0022-5347(17)71952-0. doi.
Mahmoud-Ahmed AS, Suh JH, Kupelian PA, et al. Brain metastases from bladder carcinoma: presentation, treatment and survival. J Urol. 2002;167(6):2419–22. Epub 2002/05/07. PubMed PMID: 11992049.
Majcherczyk K, Marcinek M, Nowak M, Tkocz M. Solitary cerebellar metastasis from bladder cancer. Ann Acad Med Siles. 2021;75:123–7. doi:10.18794/aams/143349. Epub 30/12/2021.
Qasho R, Tommaso V, Rocchi G, Simi U, Delfini R. Choroid plexus metastasis from carcinoma of the bladder: case report and review of the literature. J Neurooncol. 1999;45(3):237–40. doi: 10.1023/a:1006346615463. PubMed PMID: 10845394.
Salvati M, Cervoni L, Orlando ER, Delfini R. Solitary brain metastases from carcinoma of the bladder. J Neurooncol. 1993;16(3):217 – 20. doi: 10.1007/bf01057036. PubMed PMID: 8301346.
Santarossa S, Vaccher E, Balestreri L, Volpe R, Tirelli U. Solitary meningeal recurrence in a patient with transitional cell carcinoma of the bladder with locally bulky disease at presentation. J Neurooncol. 1997;35(2):141–3. doi:10.1023/a:1005870408066. PubMed PMID: 9266450.
Shamdas GJ, McLaren GD, Grimm T, Everson LK. Solitary cerebellar metastasis from transitional cell carcinoma of bladder. Urology. 1992;40(1):50 – 3. Epub 1992/07/01. doi: 10.1016/0090-4295(92)90436-z. PubMed PMID: 1621313.
Stastny JF, Sprague RI, Frable WJ. Transitional-cell carcinoma metastatic to cerebrospinal fluid: presentation of two cases. Diagn Cytopathol. 1996;15(4):338 – 40. doi: 10.1002/(sici)1097-0339(199611)15:4<338::Aid-dc17>3.0.Co;2-p. PubMed PMID: 8982592.
Worm PVFG, Cabral RD, Kraemer JL. Cerebellar Single Metastases from Bladder Transitional Cell Carcinoma: A Case Report. Brazilian Neurosurgery: Arquivos Brasileiros de Neurocirurgia. 2016;35(2):148–51. doi:10.1055/s-0036-1583936.
Zennami K, Yamada Y, Nakamura K, Aoki S, Taki T, Honda N. Solitary brain metastasis from pT1, G3 bladder cancer. Int J Urol. 2008;15(1):96–8. doi:10.1111/j.1442-2042.2007.01935.x. PubMed PMID: 18184184.
Haberland C. Clinical neuropathology. 1st ed. New York: Demos Medical Publishing; 2007.
Moes G, Vogel H. Metastatic neoplasms of the central nervous system. 1st ed. New York: Cambridge University Press; 2009.
Walker MT, Kapoor V. Neuroimaging of parenchymal brain metastases. 1st ed. New York: Springer; 2007.
Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int. 2013;4(Suppl 4):209-19. doi:10.4103/2152-7806.111298. PubMed PMID: 23717792; PMCID: PMC3656556. Epub 2013/05/30.
Sperduto PW, Mesko S, Li J, et al. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. J Clin Oncol. 2020;38(32):3773–84. doi:10.1200/jco.20.01255. PubMed PMID: 32931399; PMCID: PMC7655019. Epub 2020/09/16.
Sarmiento JM, Wi MS, Piao Z, Stiner ES. Solitary cerebral metastasis from transitional cell carcinoma after a 14-year remission of urinary bladder cancer treated with gemcitabine: Case report and literature review. Surg Neurol Int. 2012;3:82. doi:10.4103/2152-7806.99172. PubMed PMID: 22937482; PMCID: PMC3424676. Epub 2012/09/01.
Chandra AA, Kwon YS, Braver JK, Stanford BJ, Dave DS. Isolated Metastasis to the Brain From Upper Tract Urothelial Carcinoma. Urology. 2020;145:e8–11. doi:10.1016/j.urology.2020.07.058. PubMed PMID: 32791291. Epub 2020/08/14.
Ogunbona OB, Matoso A, Cheng L, Shen S, Powell SZ, Osunkoya AO. Metastatic urothelial carcinoma to the brain, spinal cord and spine: A contemporary multi-institutional clinicopathologic analysis of 24 cases. Pathol Res Pract. 2021;224:153537. doi:10.1016/j.prp.2021.153537. PubMed PMID: 34243109. Epub 2021/07/10.
Perlmutter AE, Zaitoon A, Sparks SS, Zaslau S, Zaitoon M. Isolated cerebellar metastasis in a patient with organ-confined, lymph node negative bladder cancer. W V Med J. 2006;102(5):14–5. Epub 2007/02/09. PubMed PMID: 17285948.
Vaa B, Kohli M, Price KA, Swetz KM. Solitary cystic cerebellar metastasis in a patient with invasive transitional cell carcinoma of the bladder. BMJ Case Rep. 2014;2014. Epub 2014/06/13. doi: 10.1136/bcr-2013-200137. PubMed PMID: 24920508; PMCID: PMC4069751.
Zigouris A, Pahatouridis D, Mihos E, et al. Solitary cystic cerebral metastasis from transitional cell carcinoma of the bladder. Acta Neurol Belg. 2009;109(4):322–5. Epub 2010/02/03. PubMed PMID: 20120215.
Kim YJ, Feiden W. A 76-year-old woman with a history of bladder cancer and new brain lesion. Brain Pathol. 2007;17(3):329–30. doi:10.1111/j.1750-3639.2007.00076_2.x. PubMed PMID: 17598828; PMCID: PMC8095500.
Protzel C, Zimmermann U, Asse E, Kallwellis G, Klebingat KJ. Gemcitabine and radiotherapy in the treatment of brain metastases from transitional cell carcinoma of the bladder: a case report. J Neurooncol. 2002;57(2):141–5. doi:10.1023/a:1015730825896. PubMed PMID: 12125975. Epub 2002/07/20.
Boyle HJ, Lavergne E, Droz JP, Bonnin N, Flechon A. Brain metastases in patients with urothelial carcinoma. J Clin Oncol. 2012;30(15_suppl):e15009-e. doi:10.1200/jco.2012.30.15_suppl.e15009.
Brenneman RJ, Gay HA, Christodouleas JP, et al. Review: Brain Metastases in Bladder Cancer. Bladder Cancer. 2020;6:237–48. doi:10.3233/BLC-200304.
Rosenstein M, Wallner K, Scher H, Sternberg CN. Treatment of brain metastases from bladder cancer. J Urol. 1993;149(3):480–3. doi:10.1016/s0022-5347(17)36123-2. PubMed PMID: 8437250. Epub 1993/03/01.
Nahed BV, Alvarez-Breckenridge C, Brastianos PK, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Surgery in the Management of Adults With Metastatic Brain Tumors. Neurosurgery. 2019;84(3):E152-e5. doi:10.1093/neuros/nyy542. PubMed PMID: 30629227.
Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322(8):494–500. doi:10.1056/nejm199002223220802. PubMed PMID: 2405271. Epub 1990/02/22.
Noordijk EM, Vecht CJ, Haaxma-Reiche H, et al. The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys. 1994;29(4):711–7. doi:10.1016/0360-3016(94)90558-4. PubMed PMID: 8040016. Epub 1994/07/01.
Loeffler JS. Overview of the treatment of brain metastases. In: Wen PY, Eichler AF, editors. UpToDate. Waltham: Wolters Kluwer; 2022.
Fervenza FC, Wolanskyj AP, Eklund HE, Richardson RL. Brain metastasis: an unusual complication from prostatic adenocarcinoma. Mayo Clin Proc. 2000;75(1):79–82. Epub 2000/01/12. doi: 10.4065/75.1.79. PubMed PMID: 10630761.
Oeppen RS, Tung K. Retrograde venous invasion causing vertebral metastases in renal cell carcinoma. Br J Radiol. 2001;74(884):759–61. doi:10.1259/bjr.74.884.740759. PubMed PMID: 11511503. Epub 2001/08/21.
Batson OV. THE FUNCTION OF THE VERTEBRAL VEINS AND THEIR ROLE IN, THE SPREAD OF METASTASES. Ann Surg. 1940;112(1):138–49. doi:10.1097/00000658-194007000-00016. PubMed PMID: 17857618; PMCID: PMC1387927. Epub 1940/07/01.
Morita K, Oda M, Koyanagi M, Saiki M. Metastatic brain tumor from urothelial carcinoma of the prostatic urethra. Surg Neurol Int. 2016;7(Suppl 17):488-91. doi:10.4103/2152-7806.185784. PubMed PMID: 27512612; PMCID: PMC4960929. Epub 2016/08/12.
Bouchelouche K. PET/CT in Bladder Cancer: An Update. Semin Nucl Med. 2022;52(4):475–85. doi:10.1053/j.semnuclmed.2021.12.004. PubMed PMID: 34996595. Epub 20220105.
Goodfellow H, Viney Z, Hughes P, et al. Role of fluorodeoxyglucose positron emission tomography (FDG PET)-computed tomography (CT) in the staging of bladder cancer. BJU Int. 2014;114(3):389–95. doi:10.1111/bju.12608. PubMed PMID: 24341486. Epub 20140416.
Kim SK. Role of PET/CT in muscle-invasive bladder cancer. Transl Androl Urol. 2020;9(6):2908–19. doi:
10.21037
/tau.2020.03.31. PubMed PMID: 33457264; PMCID: PMC7807314.
Apolo AB, Riches J, Schöder H, et al. Clinical value of fluorine-18 2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in bladder cancer. J Clin Oncol. 2010;28(25):3973–8. doi:10.1200/jco.2010.28.7052. PubMed PMID: 20679618; PMCID: PMC2940395. Epub 20100802.
Kibel AS, Dehdashti F, Katz MD, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol. 2009;27(26):4314–20. doi:10.1200/jco.2008.20.6722. PubMed PMID: 19652070; PMCID: PMC4035361. Epub 20090803.
65. Kibel AS, Dehdashti F, Katz MD, et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for staging of muscle-invasive bladder carcinoma. J Clin Oncol. 2009;27(26):4314-20. Epub 20090803. doi: 10.1200/jco.2008.20.6722. PubMed PMID: 19652070; PMCID: PMC4035361.

CAREchecklist.pdf

Download PDF

Journal Publication

published 01 Jan, 2023

Read the published version in Brain and Spine →

Version 1

posted

You are reading this latest preprint version

Isolated cerebellar metastasis from urothelial carcinoma: a case report of a rare phenomenon

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Case Presentation

Clinical presentation

Imaging

Therapeutic approach

Histological findings

Post-operative follow-up

Discussion

Declarations

References

Supplementary Files

Status:

Journal Publication

Version 1