Percutaneous Biopsy Tract Seeding in a Patient with Muscle-invasive Bladder Cancer

Abstract

Percutaneous biopsy can be used for tissue diagnosis of bladder tumors when cystoscopy with transurethral resection is not possible. The largest known case series includes 15 patients with no reported complications and good concordance with surgical pathology. However, concern remains regarding exposure of nonurothelial surfaces to tumor cells, as there are rare documented cases of tumor seeding along nephrostomy and biopsy tracts in upper tract urothelial carcinoma (UC). We present the first documented human case of bladder cancer involvement of the omentum and peritoneum along a biopsy tract and review the use of percutaneous access for upper and lower tract UC.

Keywords: Bladder cancer; Percutaneous biopsy; Tumor seeding; Upper tract urothelial carcinoma.

Fig. 1

Initial computed tomography–guided percutaneous bladder biopsy.

Fig. 2

Pathology specimen from the bladder biopsy: (A) 10× view showing tumor cells (yellow arrow) infiltrating the muscularis propria (white arrow) and (B) GATA3 staining highlighting the tumor cells.

Fig. 3

Pathology specimen of omental tissue: (A) 4× view with infiltrating islands of tumor cells (arrow) eliciting a desmoplastic response and (B) GATA3 staining highlighting sheets of tumor cells with a similar immune profile to that seen in bladder biopsy tissue.

Fig. 4

Computed tomography 9 d after aborted robotic cystectomy for radiologic assessment of omental disease. Axial and coronal images demonstrate fat stranding and nodularity in the right mid and lower quadrants (yellow arrows).

Fig. 5

Follow-up computed tomography demonstrating omental disease progression. Axial and coronal images reveal bilateral peritoneal thickening and nodularity (yellow arrows), omental nodules (orange arrows), and ascites (red arrows). The bladder wall is circumferentially thickened (green arrow).