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Indian Journal of Surgery, Vol. 65, No. 4, July-Aug, 2003, pp. 378-379 Case Report Metastatic breast disease causing ureteric obstruction and haematuria A. Shah Department of Urology, Whipps Cross University Hospital, London.
How to cite this article: Shah A. Metastatic breast disease causing ureteric obstruction and haematuria. Indian J Surg 2003;65:378-80. Paper Received: April 2001. Paper Accepted: October 2002. Source of Support: Nil Code Number: is03079 Abstract We report a 96-year old lady who had previously undergone simple right mastectomy for a grade 3 infiltrating duct carcinoma presenting with painless haematuria. Imaging studies revealed right sided hydronephrosis with a lower ureteric mass invading the bladder mass. Cystoscopic examination confirmed a solid lesion on the left side of the trigone, which was resected. The histology was consistent with metastatic infiltrating carcinoma of the breast. This case is reported to highlight the rarity of the breast carcinoma metastasizing to the bladder. Key words: metastatic breast carcinoma, metastasis to ureter Case Report A 96-year-old lady presented with a history of painless frank haematuria. Her past medical history included a simple right mastectomy for a Grade 3 infiltrating ductal carcinoma with vascular invasion. She remained clinically free from disease during follow-up. General examination was unremarkable except for pallor. The patient was anaemic (hemoglobin 7.9) and had some degree of renal impairment (S. creatinine 1.7 mg%). Ultrasound examination showed a left hydronephrosis with a mass in the lower left ureter invading through the bladder wall. CT scan demonstrated a 2.5-cm ill-defined lesion in the bladder, obstructing the left ureter near the vesico-ureteric junction (Figure 1). There were no metastases in the liver, nor any free fluid in the abdomen. The chest X-ray was clear and there was no evidence of disease elsewhere. Bimanual examination, prior to cystoscopy, demonstrated a mobile mass on the left side of the pelvis. Cystoscopy showed a solid lesion on the left side of the trigone, which was resected. The resulting histology (Figure 2) was consistent with metastatic infiltrating carcinoma of the breast and was very similar in appearance to the original histology. Discussion Although metastatic breast carcinoma is common, metastasis to the bladder is a very rare finding. Abrams et al, in an analysis of 1000 autopsies, found 4 cases of bladder metastasis in 167 cases of metastatic breast carcinoma.1 Furthermore, the majority of cases of metastases to the bladder reported in the literature refer to widespread terminal breast cancer.2 This case is unique in that the lower ureter and bladder appeared to have been the only organs affected by the metastatic disease. In the literature, bladder metastasis presentation ranges from macroscopic haematuria to back pain and irritative voiding symptoms. On rare occasions hydronephrosis has been demonstrated at presentation.3 Although a rare diagnosis, the practising urologist should be aware of the possibility that breast cancer may metastasize to the ureter. Acknowledgement Dr. K. Jain, Consultant Histopathologist, Whipps Cross Hospital. References 1. Abrahms HL, Spiro R, Goldstein N. Metastases in carcinoma - analysis of 1000 autopsied cases. Cancer 1950;3:74. 2. Schneidau T, Stroumbakis N, Choudhary M, Eshgi M. Metastatic breast cancer to the bladder. Int J Urol Nephrol 1995;29: 297-300. 3. Williams JR, Stott MA, Moisey CU. Bilateral hydronephrosis secondary to breast carcinoma metastasizing to the bladder. Br J Urol 1992;69:97-8. © 2003 Indian Journal of Surgery. Also available online at http://www.indianjsurg.com The following images related to this document are available:Photo images[is03079f2.jpg] [is03079f1.jpg] |
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