Case Letter
Metastatic urothelial carcinoma
Elisabeth Gómez-Moyano
, Silvestre Martínez Garcia, David Hernandez Alcaraz, Maria Ayala-Blanca
Corresponding author
Hospital Regional Universitario de Málaga, Malaga, Spain
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"eligm80@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Silvestre" "apellidos" => "Martínez Garcia" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "Hernandez Alcaraz" ] 3 => array:2 [ "nombre" => "Maria" "apellidos" => "Ayala-Blanca" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Regional Universitario de Málaga, Malaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2698 "Ancho" => 1674 "Tamanyo" => 889868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple erythemato-violaceous nodules on the trunk (A) and the scalp (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 61-year-old-man of the South of Spain presented at the Dermatology Department at Hospital Regional Universitario de Malaga with multiple painful erythemato-violaceous nodules on the chin, on the trunk, and the scalp (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had been diagnosed with muscle-invasive micropapillary bladder cancer one year before and received treatment with radiotherapy and chemotherapy with cisplatin in a sparring bladder protocol treatment. A skin biopsy of the trunk was performed, showed medium-sized atypical cells arranged in nests or sheets, which exhibited round–ovoid nuclei and abundant eosinophilic cytoplasm, and they formed small rosette-like aggregates, in the superficial and deep dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemical stains with CK-20 and CK-7 were positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The abdominal-pelvic CT image showed diffuse wall bladder thickening after therapy have been finished.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Multiple brain lesions compatible with metastasis were observed in the cranial MRI. Computerized tomography showed mediastinal lymph nodes, subcutaneous nodules, and pulmonary parenchyma infiltration compatible with carcinomatous lymphangitis. The scintigraphy image showed multiple bone metastases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient started treatment with pembrolizumab, oral corticosteroids and holocranial radiotherapy (20 Gy), but he died seven months later.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The urothelial carcinomas are the second most common genitourinary tumors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The localized disease represents about 80% of cases, with the remainder presenting with regional or distant involvement.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The most usual sites of metastases are the lymph nodes, liver, lung, bone, and rarely, brain metastases. Skin metastases from urothelial cancers are uncommon, with an incidence of 0.84%–3.6% and they are considered to be a poor prognostic sign. Metastatic infiltration of the skin may occur due to:<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> a) Direct tumor extension; b) Hematogenous or lymphatic spreading; c) Iatrogenic implantation of tumor cells.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis requires a high index of clinical suspicion and histological confirmation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The clinical presentation is quite diverse, and most commonly includes isolated nodular subcutaneous metastases. However, patients also present with diffuse, erythematous, raised infiltrates within the skin. Zosteriform pattern, extramammary Paget’s disease, have been documented. Erythema gyratum repens and acanthosis nigricans as paraneoplastic disorders have been reported.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A case of urothelial cutaneous metastasis mimicking condylomata acuminate has been reported. Penile metastasis from primary bladder cancer is an extremely rare event.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Prognosis of patients with bladder cancer cutaneous spreading is generally poor with less than 1-year median survival.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The optimal treatment of urothelial bladder cancer with micropapillary variant histology remains not clear.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although this tumor is associated with adverse clinicopathological features, a recent meta-analysis suggests that micropapillary urothelial bladder cancer does not necessarily mandate different treatment algorithms.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Optimal management of patients with cT1 (tumor invades subepithelial connective tissue, clinical-stage) remains divergent. Each case should be discussed individually considering other clinicopathological factors and discuss management options as part of a shared decision-making process.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0060" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Elisabeth Gómez-Moyano: Data curation; formal analysis; investigation; methodology; project administration; software; supervision; validation; visualization; roles/writing – original draft; writing – review.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Silvestre Martínez Garcia: Formal analysis; investigation; methodology; project administration; software; supervision; validation; visualization; roles/writing – original draft; writing – review.</p><p id="par0075" class="elsevierStylePara elsevierViewall">David Hernandez Alcaraz: Formal analysis; investigation; methodology; project administration; supervision validation; visualization; roles/writing – original draft; writing – review.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Maria Ayala-Blanca: Investigation; methodology; project administration; supervision; validation; visualization; roles/writing – original draft; writing – review.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-06-03" "fechaAceptado" => "2020-06-23" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Gómez-Moyano E, Martínez Garcia S, Hernandez Alcaraz D, Ayala-Blanca M. Metastatic urothelial carcinoma. An Bras Dermatol. 2021;96:519–20.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Regional Universitario de Málaga, Malaga, Spain.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2698 "Ancho" => 1674 "Tamanyo" => 889868 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Multiple erythemato-violaceous nodules on the trunk (A) and the scalp (B).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1701 "Ancho" => 1674 "Tamanyo" => 459280 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Medium-sized tumor cells arranged in nests (Hematoxylin & eosin, ×400).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous manifestations of genitourinary malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. 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Cherif" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eucr.2016.11.028" "Revista" => array:6 [ "tituloSerie" => "Urol Case Rep" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "17" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28083478" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Micropapillary urothelial carcinoma of the bladder: a systematic review and meta-analysis of disease characteristics and treatment outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Abufaraj" 1 => "B. Foerster" 2 => "E. Schernhammer" 3 => "M. Moschini" 4 => "S. Kimura" 5 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 7 | 23 |
| 2024 October | 114 | 71 | 185 |
| 2024 September | 128 | 89 | 217 |
| 2024 August | 178 | 115 | 293 |
| 2024 July | 139 | 112 | 251 |
| 2024 June | 120 | 78 | 198 |
| 2024 May | 95 | 67 | 162 |
| 2024 April | 117 | 85 | 202 |
| 2024 March | 144 | 69 | 213 |
| 2024 February | 185 | 75 | 260 |
| 2024 January | 130 | 51 | 181 |
| 2023 December | 71 | 64 | 135 |
| 2023 November | 85 | 76 | 161 |
| 2023 October | 76 | 68 | 144 |
| 2023 September | 75 | 63 | 138 |
| 2023 August | 80 | 35 | 115 |
| 2023 July | 83 | 27 | 110 |
| 2023 June | 85 | 44 | 129 |
| 2023 May | 63 | 22 | 85 |
| 2023 April | 46 | 18 | 64 |
| 2023 March | 63 | 41 | 104 |
| 2023 February | 51 | 32 | 83 |
| 2023 January | 44 | 44 | 88 |
| 2022 December | 64 | 30 | 94 |
| 2022 November | 58 | 59 | 117 |
| 2022 October | 70 | 67 | 137 |
| 2022 September | 48 | 61 | 109 |
| 2022 August | 50 | 47 | 97 |
| 2022 July | 48 | 66 | 114 |
| 2022 June | 52 | 59 | 111 |
| 2022 May | 39 | 58 | 97 |
| 2022 April | 48 | 51 | 99 |
| 2022 March | 50 | 71 | 121 |
| 2022 February | 32 | 42 | 74 |
| 2022 January | 58 | 87 | 145 |
| 2021 December | 56 | 75 | 131 |
| 2021 November | 57 | 77 | 134 |
| 2021 October | 104 | 84 | 188 |
| 2021 September | 110 | 88 | 198 |
| 2021 August | 107 | 91 | 198 |
| 2021 July | 97 | 63 | 160 |
| 2021 June | 55 | 52 | 107 |
| 2021 May | 7 | 16 | 23 |
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