Solitary skin metastasis adjacent to ureterocutaneostomy 4 years after radical cystectomy for bladder cancer

摘要

A 65-year-old Japanese woman underwent radical cystectomy and right nephroureterectomy for muscle-invasive bladder cancer. A left ureterocutaneostomy was constructed for urinary diversion. There was no evidence of recurrence for 4 years after the surgery. At 54 months after the surgery, however, she was referred with a chief complaint of painless skin erosion around the stoma. An incisional biopsy of the lesion showed no evidence of malignancy. Thereafter, the lesion was treated as a benign skin erosion. However, the erosion expanded over the next 4 months, and a second incisional biopsy revealed that the erosion was overlying malignant cells. Computed tomography showed a skin tumor of 4 cm in diameter. No other metastases were revealed on whole-body imaging examinations. Urine cytology was negative. A skin tumor extirpation was performed, and the specimen showed that the skin tumor consisted of malignant growth of papillary cells adjacent to the ureter, which were identical to those of the primary bladder cancer. A malignant component was not observed in the lumen of the resected ureter. No evidence of disease was observed in the first 3 months after extirpation. Reports of solitary skin metastasis from bladder cancer are rare, and only a few cases have been reported in the English literature. Because skin metastasis from bladder cancer can mimic a number of different benign conditions, a high index of suspicion may be necessary to make a definitive diagnosis.