Clinical case presentation:

An 80-year-old man was admitted to our emergency department due to fever and a progressively growing mass in the urinary diversion stoma, four months after radical cystectomy for muscle-invasive bladder cancer.

Surgical resection was done, and histopathologic examination revealed high-grade urothelial carcinoma metastasis. After nearly three years of follow-up, no signs of recurrence have been seen.

Relevance:

Urothelial cancer at all stages can metastasize to other organs.

Hematogenous metastasis spreads to all organs, most frequently to the lungs, liver, or bone and lymphatic metastasis spreads to regional lymph nodes in the pelvis, or further, to the retroperitoneal lymph nodes. Metastatic bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has been reported in ureteroileal anastomoses.

Clinical implications:

Surgical treatment is an option in those patients. Adjuvant radiotherapy and/or chemotherapy are possible alternatives in cases of more than one metastasis site. There are no clinical guidelines establishing correct management.

Conclusion:

Urinary diversion stoma metastasis secondary to urothelial carcinoma is a rare entity. Direct implantation during the surgical act, or hematogenous, lymphatic, or mixed dissemination, could justify metastatic implantation.