Incidental Identification of Metastatic Urothelial Carcinoma Presenting In an Incarcerated Ventral Hernia Sac

Abstract

Metastatic urothelial carcinoma in an incarcerated ventral hernia is exceedingly rare. Herein, we report a case of a 52 year-old man who had multiple incarcerated ventral hernias with metastatic urothelial carcinoma. Patient with a set of large abdominal wall hernias initially presented in septic shock with small bowel obstruction complicated by perforation, for which he required emergent exploration and repair of the hernias. Grossly, the "hernia sac" specimen consisted of firm fibromembranous tissue with an infiltrating tan-white mass. Histologically, the hernia sac revealed extensive tumor infiltrates in a background of desmoplastic stroma accompanied by fibrinoid necrosis. The tumor showed nests and sheets like growth pattern with predominant squamous differentiation. Immunohistochemical analysis showed the tumor to be diffusely and strongly positive for GATA3, 34betaE12, CK5/6 and P63, focally (5%) and weakly positive for CDX2, negative for CK20, D2-40, calretinin. The morphology and immunohistochemical profile supported the diagnosis of metastatic urothelial carcinoma with squamous differentiation. The patient died two weeks postsurgery. GATA3 immunoreactivity plays an important role in distinguishing urothelial carcinoma from squamous cell carcinoma and prostate carcinoma.