Labia majora metastasis secondary to transitional cell cancer of the bladder – a rare cutaneous manifestation of a common urological neoplasm

Abstract

An 82-year-old female underwent anterior exenteration, ileal conduit formation and bilateral lymphadenectomy for definitive treatment of high-grade bladder transitional cell carcinoma (TCC) with muscle invasion (G3 pT2). On initial diagnosis, transurethral resection of bladder tumour (TURBT) and a cycle of mitomycin C were performed. Staging computed tomography (CT) confirmed the tumour was organ confined. The patient also had hypertension, chronic kidney disease stage 3 and a left pelvic kidney. She had an anterior resection performed for a colonic fistula secondary to diverticular disease.After surgery, she was sixteen followed up regularly in clinic with CT scans at nine, and twenty-four months. Ten months following her last scan, she attended clinic with a painful lymph node in the right groin. Biopsy revealed poorly differentiated carcinoma consistent with metastatic bladder TCC. CT scan showed enlarged right inguinal lymph nodes and less prominent left inguinal lymph nodes. Incidentally, in the same month, she had presented to her general practitioner experiencing offensive smelling, blood-stained vaginal discharge. Examination found a 1 cm ulcerated, cystic lesion on the anterior tip of the right labia majora. This prompted referral to the gynaecology team and a wedge biopsy was performed. Pathological analysis revealed intact, non-dysplastic squamous cell epithelium of vulval mucosa with an underlying nodule of poorly differentiated carcinoma (see Figures 1 and 2). The biopsy was consistent with a metastasis from TCC of the bladder. The margins were negative. Results prompted referral back to the urology team for wide local excision of the cyst.She became under joint urological and oncology care and was seen regularly in their clinic. Six months later, a small palpable, hard nodule adjacent to the patient's stoma was found. Biopsy consequently confirmed another metastatic TCC.She was referred to palliative care services and died four years following diagnosis. DiscussionThis is the first reported case of TCC metastasis to the labia majora in literature following a PubMed and OVID review back to 1955.Labia majora metastasis secondary to transitional cell cancer of the bladdera rare cutaneous manifestation of a common urological neoplasm