Metastasising Carcinoma of the Urinary Bladder Presenting as a Retro-Orbital Mass

Abstract

A 61-year-old man presented with macroscopic haematuria. Infiltrating transitional cell carcinoma of the urinary bladder was diagnosed after transurethral resection, and he was treated first with three doses of cisplatinum (100 mg/m2 at three week intervals) and then by radical cystectomy. Eleven months later he complained of progressive diplopia, which was found on computed tomography to be caused by a retro-orbital metastatic mass. There was no evidence of a space occupying lesion in the brain or of other metastases. The patient died four weeks later and permission for necropsy was refused. Despite the fact that carcinoma of the urinary bladder rarely metastasis in this way, urologists should be aware that it can happen.

Metastasis to the Orbit from Transitional Cell Carcinoma of the Bladder

“…4 A review of the English-and Japanese-language literature (Table 1), in addition to the current report, indicates that there have been 12 other reported cases of metastases to the orbit from TCC of the bladder. [5][6][7][8][9][10][11][12][13][14][15] Of these 13 cases, 11 were in men and 2 were in women, and the average patient age was 63.5 years. The time period from onset of primary TCC to observation of ocular symptoms was 3 weeks to 11 years.…”

Transitional Cell Carcinoma of the Urinary Bladder Metastatic to the Orbit

“…6 -12 Five of these patients were diagnosed with bladder cancer before orbit involvement, although one of these was a presumed metastasis that was not biopsy- proven. 12 Two were initial presentations, one of which presented with bilateral orbital metastases and the primary tumor simultaneously. 10 Our patient had an 11-year history of TCC, but was felt to be in remission after a single recurrence 4 years prior to presentation.…”

Clinical Reasoning: A 59-year-old man with multifocal strokes, then subsequent painful eye movements and diplopia

“…4 There are fewer than 25 cases of urothelial carcinoma metastatic to the orbit reported in the literature; they usually present with a known cancer history that has been treated with chemotherapy or radiation. [5][6][7][8] This case of urothelial carcinoma with orbital metastasis presenting with an unknown primary neoplasm is very rare. In most published cases, the longest duration of time between diagnosis and urothelial orbital metastasis was 4 years, and those patients died within 6 months.…”