A RARE CASE OF BLADDER CANCER
Discussion: Bladder cancer is often reported in Caucasians in their 7th or 8th decade of life and is often associated with tobacco abuse. This case discusses an aggressive lesion in a young man without tobacco use. <1% of cancers are described as Neuroendocrine in origin. Their occurrence in the bladder is rare and often diagnosed in an advanced stage with a poor prognoses. NET can be further subdivided into large and small cell carcinomas, neither of which are reported here.
mortality which could be decreased given appropriate precautions and treatment. Complications can include esophageal perforation, mediastinitis, and abscess formation which can be seen in up to 6% of cases. Late complications include esophageal strictures and stenosis which are seen in 10.2% of cases and may appear as early as 7-12 days after diagnosis. Mortality is as high as 32% with underlying co-morbidities and the mortality specific to AEN is closer to 6%.
B. Tymchuk; N.Silva; M. Eschete; G. Lacy Department of Internal Medicine, Leonard J. Chabert Medical Center, Houma Introduction: Cancer with an unknown primary is common, accounting for 4 to 5 percent of all invasive cancers. Neuroendocrine tumor (NET) of the bladder is exceedingly rare, accounting for 0.5% of all bladder tumors. NET is classified into 2 subtypes: carcinoid tumor and neuroendocrine carcinoma. Neuroendocrine carcinoma is further subdivided into small cell carcinoma (SCC) and large cell neuroendocrine carcinoma, the latter of which is exceedingly rare in the bladder. Case: A 36 year old man without previous medical history who presented with gross hematuria for 2 days associated with urgency, frequency, hesitancy, dysuria, penile pain and left flank pain. He had no personal history of kidney disease nor occupational exposures. He was afebrile with normal vitals and liquid labs revealed a mild paraproteinemia with a gap of 4.3, a baseline BUN and Creatinine of 21 and 1.3 respectively. UA was red tinged, with 2+ protein, 3+ occult blood, trace ketones and micro revealed >100+ RBC’s. Urine and blood cultures were without organisms. CT abdomen/ pelvis revealed left hydronephrosis and hydroureter with renal cortical atrophy consistent with chronic obstruction. CT urogram revealed no pyelogram on the left, due to a 7.5 x 5.5 cm mass along the left posterolateral bladder wall separate from prostate obstructing the left distal ureter. Within a month his symptoms progressed to chronic hematuria and recurring obstruction, requiring nephrostomy tube placement, ureteral stenting, biopsy of bladder mass and subsequent TURBT with clot evacuation and fulguration. Further cancer screening did not reveal a primary source for his malignancy. Pathology demonstrated an invasive high-grade malignant neoplasm with a neuroendocrine differentiation, staining positive for synaptophysin, CD56 with a Ki67 proliferative index of ~70- 75%. Tumor was negative for CK7, CK20, CD 45PSA, PSAP, AE1/AE3 and RCC.
19 J LA MED SOC | VOL 171 | NO. 1
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