Transitional cell carcinoma of the bladder in an 82-year-old man metastasized diffusely to the entire lower half of the skeletal system starting from the L-4 vertebra without any evidence of metastasis elsewhere. The patient had tumor fulguration, bladder infusion chemotherapy, radical cystoprostatectomy, and external beam pelvic radiation therapy (3000 rads) which had ended 5 months earlier. The patient also received an unknown amount of radiation therapy to the spine for arthritis 40 years ago. It is tempting to postulate that radiation-induced fibrosis of the thoracolumbar marrow prevented seeding and growth of the tumor cells, but the true mechanism of the observed phenomenon is unknown.
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