Metastatic Urinary Bladder Carcinoma on Palliative Chemotherapy Showing Rapid Progression on Interim Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Abstract

Bladder cancer (BC) is among the top ten most common cancer types globally. Muscle invasive BC has a high incidence of metastasis. Metastatic BC has a poor prognosis and limited treatment options. Here, we present a middle-aged man with oligometastatic BC, which was treated with palliative chemotherapy. He had significant clinical improvement. However, interim 18F-Fluorodeoxyglucose positron emission tomography/computed tomography demonstrates a rapid disease progression extensive metastasis.

Keywords: Fluorodeoxyglucose positron emission tomography/computed tomography; metastatic disease; progressive disease; treatment response evaluation; urinary bladder carcinoma.

Figure 1

(a) Maximum intensity projection images of baseline 18-F fluorodeoxyglucose positron emission tomography/computed tomography revealed fluorodeoxyglucose avid lesion in the urinary bladder (black arrow) and few nodules in the lungs (blue arrow). (b) Fused whole-body coronal images show fluorodeoxyglucose avid thickening of urinary bladder (black arrow). (c and d) Follow-up maximum intensity projection and fused coronal images reveal residual thickening in the urinary bladder. Apart from that, multiple areas of uptake are noted in retroperitoneal lymph nodes (blue arrow), mediastinal lymph node, lung (blue arrow), and liver (red arrow)

Figure 2

Baseline (a-d) trans-axial images fused positron emission tomography/computed tomography show mass involving the anterosuperior wall of urinary bladder (white arrow). A faintly fluorodeoxyglucose avid nodule is noted in the upper lobe of the left lung (red arrow). The liver and retroperitoneum are unremarkable. Follow-up fluorodeoxyglucose positron emission tomography/computed tomography images (e-h) reveal residual primary (white arrow in e) lesion of the urinary bladder. Fluorodeoxyglucose avid nodule in the upper lobe of the left lung (red arrow in f) with supraclavicular and mediastinal lymph nodes (blue arrows) are seen. Extensive fluorodeoxyglucose avid (red arrows in g) hepatic lesions are noted with a bone lesion in the D8 vertebra (white arrow in g). Multiple fluorodeoxyglucose avid (white arrow, h) retroperitoneal lymph nodes are noted