cqvip:Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to describing the EUS feature s of recurrent metastatic TCBC, this study determined the number of patients ref erred for evaluation of a primary GI luminal cancer in which EUS instead establi shed the diagnosis of metastatic recurrent TCBC. Methods: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI lumin al cancer were retrospectively reviewed. For patients with an established diagno sis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to id entify characteristic features. Results: Of 2216 patients undergoing EUS to eval uate a suspected primary GI luminal cancer, 3 men (0.14% : 95% confidence int erval [0.02% , 0.29% ]) (mean age 67 years, range 54- 74 years) were found in stead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the prim ary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal steno sis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. E US demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia- like extensions into the peri- intestinal t issues. In the two patients with rectal involvement, no evidence of direct infil tration from the bladder bed was seen. EUS- guided FNA was diagnostic of metast atic TCBC in all patients. Conclusions: Although most cases of hypoechoic bowel - wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC sh ould be considered in patients with a history of this tumor. Correct diagnosis i s important, because this allows selection of appropriate therapeutic interventi ons. Although firm EUS criteria for TCBC cannot be established based on findings in 3 patients, certain features may prove useful. EUS- guided FNA can confirm the diagnosis.
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