Metastatic signet-ring cell cancer of the bladder responding to chemotherapy with capecitabine: case report and review of literature

Abstract

Signet-ring cell cancers deriving from the bladder are rare entities and usually present with advanced incurable disease and associated poor outlook. No standard effective chemotherapeutic option has been described largely due to the rarity of this malignancy. We report a case of a patient with metastatic bladder cancer, signet-ring cell variant. The patient progressed rapidly on standard first-line bladder cancer chemotherapy with gemcitabine and carboplatin. He responded well to second-line capecitabine with a clinically meaningful progression-free survival.

Widespread osseous metastasis of signet ring type bladder cancer detected by NaF18-PET/CT bone scan

“…He was started on carboplatin and gemcitabine palliative chemotherapy. However, no effective systemic chemotherapy has been established for this subtype of bladder cancer [8] . Patients with signet-ring cell carcinoma of the bladder have lower survival rates compared to patients with urothelial carcinoma of the bladder [16] .…”

“…Other less common types are squamous cell type 3%, adenocarcinomas 2% and small cell tumors <1% [2] . Adenocarcinomas can assume signet ring type histology and the prevalence of this type is only 0.24% of all primary bladder cancers [8] . Signet ring morphology is described as abundant in cytoplasm with the nucleus pushed to one side [9] .…”

Metastatic signet-ring cell carcinoma of the urinary bladder: A novel management approach to a rare tumor.

“…Our case, however, highlights the use of the FOLFOX-6 regimen specifically and is the first to report treatment response of an osseous metastasis. 5,12 Similarly, one report describes response to palliative chemotherapy with the FOLFOX-6 regimen plus bevacizumab in the treatment of typical bladder adenocarcinoma, but ours is the first to describe response of the signet-ring cell variant specifically, and with the use of FOLFOX-6 alone. 13 Our patient's response to FOLFOX-6 supports the use of a therapy traditionally aimed at gastrointestinal malignancies for the treatment of metastatic SRCC of the bladder.…”

Delayed post gastrectomy haematuria: A rare distant site of signet ring cell carcinoma metastasis

“…In managing cases of bladder secondary, the severity or stage of the primary tumour will determine the definite management. 1 In most cases of bladder secondary due to direct extension by surrounding organ, radical pelvic exantration may give hope for total tumour irradiation. 7 On the other hand, in cases of distant spread the prognosis is poor and more towards palliative management.…”

“…Both are considered as adenocarcinoma of the urinary bladder which comprised about 0.5-0.2% of all bladder cancer. 1 Majority of metastatic signet ring carcinoma manifest as part of disseminated disease. The most common site of primary is the stomach.…”