A rare case of synchronous bilateral epididymal and testicular metastases of urothelial carcinoma of the bladder after i
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CASE REPORT
A rare case of synchronous bilateral epididymal and testicular metastases of urothelial carcinoma of the bladder after intravesical bacillus Calmette–Guérin Naotaka Nishiyama1 · Yoshinori Ikehata1 · Noriko Okuno2 · Masakiyo Sasahara2 · Ippei Sakamaki3 · Yoshihiro Yamamoto3 · Hiroshi Kitamura1 Received: 3 July 2020 / Accepted: 20 September 2020 © The Japan Society of Clinical Oncology 2020
Abstract A 68-year-old man was diagnosed with non-muscle-invasive bladder cancer and underwent transurethral resection of the bladder tumor (TURBT) in June 2014. The pathological diagnosis was urothelial carcinoma (UC), Grade 2, pT1. He was treated with intravesical bacillus Calmette–Guérin (BCG) instillation after TURBT. In February 2016, he received anti-tuberculosis treatment for systemic BCG infection, and tuberculosis treatment was continued. In September 2018, he presented with bilateral scrotum swelling and underwent bilateral orchiectomy following a diagnosis of antituberculotics-resistant epididymitis. The pathological findings were metastatic UC of the bilateral epididymis and testis. One months later, fluorodeoxyglucosepositron emission tomography/computed tomography showed para-aortic lymph node and peritoneal metastases. He was treated with chemotherapy of gemcitabine and cisplatin. We herein report a very rare case of synchronous metastatic UC of the bilateral epididymis and testis after intravesical BCG treatment. Keywords Testicular metastases · Bladder cancer · Intravesical bacillus Calmette–Guérin
* Naotaka Nishiyama [email protected]‑toyama.ac.jp Yoshinori Ikehata [email protected]‑toyama.ac.jp Noriko Okuno [email protected]‑toyama.ac.jp Masakiyo Sasahara [email protected]‑toyama.ac.jp Ippei Sakamaki [email protected]‑toyama.ac.jp Yoshihiro Yamamoto [email protected]‑toyama.ac.jp Hiroshi Kitamura [email protected]‑toyama.ac.jp 1
Department of Urology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930‑0194, Japan
2
Department of Pathology, Faculty of Medicine, University of Toyama, Toyama, Japan
3
Department of Clinical Infectious Diseases, Toyama University Hospital, Toyama, Japan
Abbreviations NMIBC Non-muscle-invasive bladder cancer BCG Bacillus Calmette–Guérin UC Urothelial carcinoma MIBC Muscle invasive bladder cancer TURBT Transurethral resection of the bladder tumor CT Computed tomography RFP Rifampicine INH Isoniazid EB Ethambutol MRI Magnetic resonance imaging EORTC European Organization for Research and Treatment of Cancer
Introduction About 70% of patients with bladder cancer are diagnosed with non-muscle-invasive bladder cancer (NMIBC), and the incidence of intravesical recurrence is more than 50% [1]. Intravesical bacillus Calmette–Guérin (BCG) therapy is useful for the adjuvant treatment of patients with highand intermediate-risk NMIBC [2–4]. However, in high-risk patients, which includes patients with Ta/T1 high grade
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urothelial carcinoma (UC) and or carcinoma in situ, the disease becomes muscle-invasive bladder cancer (MIBC) in 10
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