Case Letter
Metastatic urothelial carcinoma
Elisabeth Gómez-Moyano
, Silvestre Martínez Garcia, David Hernandez Alcaraz, Maria Ayala-Blanca
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Hospital Regional Universitario de Málaga, Malaga, Spain
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[ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221001302?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621001288?idApp=UINPBA00008Z" "url" => "/03650596/0000009600000004/v4_202107160617/S0365059621001288/v4_202107160617/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Letter</span>" "titulo" => "Metastatic urothelial carcinoma" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "519" "paginaFinal" => "520" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elisabeth Gómez-Moyano, Silvestre Martínez Garcia, David Hernandez Alcaraz, Maria Ayala-Blanca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Elisabeth" "apellidos" => "Gómez-Moyano" "email" => array:2 [ 0 => "elisabeth.gomez.moyano@gmail.com" 1 => "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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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 16 | 7 | 23 |
| 2024 Outubro | 114 | 71 | 185 |
| 2024 Setembro | 128 | 89 | 217 |
| 2024 Agosto | 178 | 115 | 293 |
| 2024 Julho | 139 | 112 | 251 |
| 2024 Junho | 120 | 78 | 198 |
| 2024 Maio | 95 | 67 | 162 |
| 2024 Abril | 117 | 85 | 202 |
| 2024 Março | 144 | 69 | 213 |
| 2024 Fevereiro | 185 | 75 | 260 |
| 2024 Janeiro | 130 | 51 | 181 |
| 2023 Dezembro | 71 | 64 | 135 |
| 2023 Novembro | 85 | 76 | 161 |
| 2023 Outubro | 76 | 68 | 144 |
| 2023 Setembro | 75 | 63 | 138 |
| 2023 Agosto | 80 | 35 | 115 |
| 2023 Julho | 83 | 27 | 110 |
| 2023 Junho | 85 | 44 | 129 |
| 2023 Maio | 63 | 22 | 85 |
| 2023 Abril | 46 | 18 | 64 |
| 2023 Março | 63 | 41 | 104 |
| 2023 Fevereiro | 51 | 32 | 83 |
| 2023 Janeiro | 44 | 44 | 88 |
| 2022 Dezembro | 64 | 30 | 94 |
| 2022 Novembro | 58 | 59 | 117 |
| 2022 Outubro | 70 | 67 | 137 |
| 2022 Setembro | 48 | 61 | 109 |
| 2022 Agosto | 50 | 47 | 97 |
| 2022 Julho | 48 | 66 | 114 |
| 2022 Junho | 52 | 59 | 111 |
| 2022 Maio | 39 | 58 | 97 |
| 2022 Abril | 48 | 51 | 99 |
| 2022 Março | 50 | 71 | 121 |
| 2022 Fevereiro | 32 | 42 | 74 |
| 2022 Janeiro | 58 | 87 | 145 |
| 2021 Dezembro | 56 | 75 | 131 |
| 2021 Novembro | 57 | 77 | 134 |
| 2021 Outubro | 104 | 84 | 188 |
| 2021 Setembro | 110 | 88 | 198 |
| 2021 Agosto | 107 | 91 | 198 |
| 2021 Julho | 97 | 63 | 160 |
| 2021 Junho | 55 | 52 | 107 |
| 2021 Maio | 7 | 16 | 23 |
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