Isolated bladder metastasis causing large bowel obstruction: a case report of an atypical presentation of intussusception

Abstract

Intussusception of the large bowel is a rare clinical entity. In adults, this pathology is usually associated with a malignant lead point and often requires operative management. Reported is the case of an 83-year-old female who was recently diagnosed with superficial bladder cancer (T1) treated by partial cystectomy. She presented 3 months post-operatively with an isolated mucosal metastasis of the transverse colon causing intussusception and large bowel obstruction. The patient was successfully treated by colonic resection with primary anastomosis. Histology was significant for a pedunculated sarcomatoid bladder carcinoma originating from the colonic mucosa with incomplete invasion of the bowel wall. An isolated mucosal metastasis of this variety has not been reported in the literature to date.

Figure 1.

CT Scan abdomen with evidence of intussusception at the transverse colon.

Figure 2.

Low power colectomy specimen displaying tumor replacement of the normal colonic mucosa with protrudes into the lumen.

Figure 3.

Area of original biopsy showing traditional urothelial carcinoma (upper left) and poorly-differentiated/sarcomatoid area (lower right).

Figure 4.

Metastasis specimen showing poorly-differentiated/sarcomatoid area.

Figure 5.

Strong, diffuse staining for vimentin supporting sarcomatoid differentiation.