Background: A 44-year-old patient presented with intermittent macroscopic hematuria on a background of chronic left-sided hydronephrosis and intestinal metaplasia of the bladder. Cystoscopic examination revealed a mass at the dome of the urinary bladder, which was resected. Histopathologic analysis of the specimen confirmed the presence of muscle-invasive adenocarcinoma. Radical cystectomy with curative intent was planned, but review of systems and subsequent CT demonstrated pleural effusion with positive cytology, confirming metastatic disease. Owing to the histologic similarity between this patient's tumor and colorectal cancer, palliative FOLFOX6 (folinic acid, 5-fluorouracil and oxaliplatin) chemotherapy plus bevacizumab was administered. After 3 months of treatment the patient showed a good response, which was sustained for more than 10 months after diagnosis. However, his disease subsequently relapsed, and the patient died shortly thereafter.
Investigation: Physical examination, cystoscopy, transurethral resection of bladder tissue, CT, histopathologic, cytopathologic and immunohistochemical analysis.
Diagnosis: Metastatic adenocarcinoma of the urinary bladder.
Management: 12 cycles of infused and bolus 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX6) plus bevacizumab.