Synchronously detected secondary signet ring cell urinary bladder malignancy from the stomach masquerading as genitourinary tuberculosis

Abstract

Secondary bladder neoplasms are very rare and represent 1% of all malignant bladder tumours. Among secondary bladder tumours, metastasis from the stomach accounts for about 4% of cases. These secondary tumours are generally detected during follow-up of patients already treated for gastric cancer. We report a case of metastatic adenocarcinoma of the urinary bladder from an occult primary poorly differentiated signet ring cell type gastric carcinoma masquerading clinically as genitourinary tuberculosis. Our case illustrates the importance of obtaining a bladder biopsy in suspected chronic inflammatory conditions such as urinary tract tuberculosis before starting medical management to avoid the serious consequences of missing a bladder malignancy.

Figure 1

CECT of the abdomen, axial section, showing diffuse thickening of stomach and urinary bladder wall with ascites.

Figure 2

(A) Bladder biopsy showing poorly differentiated carcinoma (H&E×100). (B,C,D) Immunohistochemistry showing neoplastic cells strongly positivity for cytokeratin 7(B), CDX2(C) and negative for p63(D) (×100).

Figure 3

Upper gastrointestinal endoscopic image demonstrating an ulcerative lesion along the lesser curvature of the stomach.

Figure 4

Biopsy from the stomach showing a poorly differentiated signet ring cell gastric adenocarcinoma with overlying normal gastric glands. (A) (H&E×40). (B) (H&E×400).