Testicular metastasis from urothelial carcinoma of the bladder

Abstract

Introduction: Reports of urothelial carcinoma with testicular metastasis are limited and the etiology and prognosis remain unclear. We report a rare case of testicular metastasis derived from bladder urothelial carcinoma.

Case presentation: A 68-year-old man presented with gross hematuria and urinary frequency. Cystoscopy demonstrated an 8-cm-sized tumor in the bladder; transurethral resection and magnetic resonance imaging confirmed invasive urothelial carcinoma. Cystoprostatourethrectomy was performed, and the pathological diagnosis was high-grade muscle-invasive urothelial carcinoma. Three years later, the patient noticed a left scrotal mass. Left high orchiectomy was performed, and histopathologic examination of the surgical specimen revealed urothelial carcinoma, confirming testicular metastasis derived from bladder cancer. The patient received chemotherapy with gemcitabine and cisplatin and has survived for 7 years since the initial diagnosis without progression.

Conclusion: Although rare, secondary lesions should be considered for the differential diagnosis of testicular tumors in patients with a history of urothelial carcinoma.

Keywords: bladder cancer; metastasis; testicular tumor; transitional cell carcinoma; urothelial carcinoma.

Fig. 1

Magnetic resonance imaging. Magnetic resonance image showing an 8‐cm tumor at the posterior wall of the bladder, which suggested possible muscle‐invasive bladder cancer.

Fig. 2

Computed tomography. Computed tomography showing a mass in the left testicle as well as the right internal‐iliac lymphadenopathy (arrow), suggesting metastatic spread of the bladder cancer.

Fig. 3

Histology. Specimen of the testis exhibiting urothelial carcinoma infiltration. (a) Hematoxylin and eosin staining, 10× magnification, and (b) 2× magnification. The specimen was positive for (c) Uroplakin3 and (d) GATA3.