A Rare Case Report of Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab

Abstract

Background: Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10–15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is no established definite treatment. Case presentation: A 64-year-old Taiwanese male presented with metastatic urothelial carcinoma (mUC) of bladder with skull invasion. A sunken forehead without painful sensation could be palpated. After failure of chemotherapy, the patient received immunotherapy pembrolizumab, and complete remission of distant metastasis with reossification of osteolytic skull were noted. Conclusion: Immunotherapy has been reported to show significant remission in mUC, but mostly in solid organs or bone. While skull metastasis usually suggests late progression of the disease, immunotherapy has fewer systemic adverse effects than chemotherapy, and should be taken into consideration as a first-line therapy.

Occult urothelial carcinoma with mediastinal metastasis: A case report

“…Globally, UC is a leading cause of cancer-related deaths and stands as the most common malignant tumor in the urinary system, with approximately half a million patients diagnosed each year ( 6 , 21 ). UC usually invades nearby tissues and organs, but a small percentage of UC cases can metastasize to distant organs, including the lymph nodes, liver, lungs, bones and adrenal glands ( 22 ). The pelvis (68%), spine (12% cervical, 38% thoracic and 34% lumbar), ribs (24%) and femurs (22%) are the most common sites of bone metastasis ( 23 ).…”

Bladder Carcinoma With Solitary Skull Metastasis: A Rare Presentation in a Middle-Aged Female

“…They are commonly urothelial carcinomas and, more commonly, not muscle invasive [1]. The patient commonly presents with hematuria and can be diagnosed by imaging, tumor resection, and cytology [4]. Computed tomography (CT) scan remains the primary imaging technique for the evaluation of bladder malignancy.…”