Urothelial carcinoma in an orthotopic neobladder: an unusual pattern of recurrence and metastasis

We report a case of a 65-year-old patient with muscle invasive bladder cancer that was treated with neoadjuvant chemotherapy, followed by radical cystoprostatectomy with pelvic lymph node dissection and orthotopic neobladder according to Hautmann. Nine years later, routine follow-up showed local recurrence in the neobladder and metastatic disease of the urothelial carcinoma in the related mesenteric lymph nodes. The entire neobladder specimen was removed including the mesentery of the neobladder. Based on the anatomical lymph drainage of the ileal neobladder, we considered the metastatic disease in the mesentery lymph node as locoregional disease spread. This case shows that such locoregional lymph node metastasis may be amenable to treatment by induction chemotherapy and radical surgery.

BMJ case reports. 2017 Oct 24*** epublish ***

Veerle H Groen, Tycho M T W T Lock, Bart de Keizer, Simon Horenblas, Richard P Meijer

Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.