Multiple cardiac complications due to sepsis and cardiac metastasis of a sarcomatoid urothelial cell carcinoma of the urinary bladder: A case report

Abstract

Introduction and importance: Of all malignancies, urinary bladder cancer is one of the most diagnosed ones. Majority of the patients with bladder cancer have a non-muscle invasive type that can be treated with conservative approaches. The sarcomatoid urothelial cell carcinoma is rare and aggressive tumour that can develop in the urinary bladder, ureter or kidney. Hereby, we present a patient that developed a cardiogenic shock due to a large cardiac metastasis of a sarcomatoid urothelial cell carcinoma.

Case presentation: A seventy-one year old male was presented at our Emergency Department with complaints/ signs of dyspnoea, low blood pressure, tachycardia/atrial fibrillation, diarrhoea and general malaise. Trans Thoracic Echocardiography (TTE) was performed which showed a mass in the left ventricle suspect of malignant origin. After five days of hospital admission the patient died due to refractory shock. Autopsy reports showed extensive cardiac, spinal, peritoneal, peripheral fat and muscle tissue metastasis, due to the sarcomatoid urothelial cell carcinoma.

Clinical discussion: Urothelial carcinomas are one of the most common urinary cancers of which sarcomatoid urothelial carcinoma is a rare, highly malignant and very aggressive type. The low incidence of this variant inhibits the conduct of randomised clinical trials and makes clinical management difficult.

Conclusion: Due to its aggressive growth rate sarcomatoid urothelial cell carcinoma have a high probability of metastasizing, however cardiac metastasis are very rare.

Keywords: Bladder cancer; Cardiac complications; Cardiac metastasis; Sarcomatoid urothelial cell carcinoma.

Fig. 1

Trans Thoracic Echocardiography (TTE) images showing mass (red arrows) in the left ventricle (blue arrows) at the base of the left ventricular septum (yellow arrows) in the endocardium. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Macroscopic pathologic examination showing extensive metastases in the endocardium, myocardium and pericardium (blue arrows) in the myocardium. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Microscopic evaluation of the cardiac metastasis due to a sarcomatoid urothelial cell carcinoma of the urinary bladder (A) compared with the original microscopic examination after the cystoprostectomy (B).