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Long-term survival and onset of granulomatous pneumonia after lung metastasectomy in a patient with non-muscle-invasive bladder cancer

  • Urology – Case Report
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Aims

This case report describes a first case of granulomatous pneumonia occurring at the same site of the previous lung metastasectomy in a patient with high-grade non-muscle-invasive bladder cancer (NMIBC), which was treated with bladder preservation therapy despite multiple recurrences and failure of intravesical bacillus Calmette-Guẻrin (BCG) therapy.

Clinical case

We report a 52-year-old woman who underwent transurethral surgery and BCG therapy for pT1, G3 bladder cancer. Although cystectomy was recommended after BCG failure, the operation was not performed because of the patient’s wish for bladder preservation. Eighteen months after the first surgery, computed tomography (CT) revealed solitary lung mass. Partial lobectomy which the patient underwent after chemotherapy revealed G3 metastatic urothelial carcinoma. Three years after lung metastasectomy, CT revealed lung mass at the same site of the previous lung metastasectomy. Dynamic contrast-enhanced magnetic resonance imaging showed the significantly enhanced lung mass, which indicated lung metastasis. However, lobectomy of the remnant lobe revealed that the lung mass was granulomatous pneumonia. Although no additional specific treatment was carried out, the patient remains free of disease for 53 months after surgery.

Conclusions

Lung metastasis from NMIBC rarely occurs. Our case report confirms that lung metastasectomy in highly selected patients may contribute to long-term disease control. Moreover, our case report suggests that mycobacterial lung infections along the staple-suture line rarely occur, and percutaneous biopsy should be considered under these circumstances to avoid the unnecessary operation.

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References

  1. Matthews PN, Madden M, Bidgood KA, Fisher C (1984) The clinicopathological features of metastatic superficial papillary bladder cancer. J Urol 132(5):904–906

    PubMed  CAS  Google Scholar 

  2. Zennami K, Yamada Y, Nakamura K, Aoki S, Taki T, Honda N (2008) Solitary brain metastasis from pT1, G3 bladder cancer. Int J Urol 15(1):96–98. doi:10.1111/j.1442-2042.2007.01935.x

    Article  PubMed  Google Scholar 

  3. Lotan Y, Gupta A, Shariat SF, Palapattu GS, Vazina A, Karakiewicz PI, Bastian PJ, Rogers CG, Amiel G, Perotte P, Schoenberg MP, Lerner SP, Sagalowsky AI (2005) Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. J Clin Oncol 23(27):6533–6539. doi:10.1200/JCO.2005.05.516

    Article  PubMed  Google Scholar 

  4. Bolenz C, Herrmann E, Bastian PJ, Michel MS, Wulfing C, Tiemann A, Buchner A, Stief CG, Fritsche HM, Burger M, Wieland WF, Hofner T, Haferkamp A, Hohenfellner M, Muller SC, Strobel P, Trojan L (2010) Lymphovascular invasion is an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy: a multicentre validation trial. BJU Int 106(4):493–499. doi:10.1111/j.1464-410X.2009.09166.x

    Article  PubMed  Google Scholar 

  5. Cho KS, Seo HK, Joung JY, Park WS, Ro JY, Han KS, Chung J, Lee KH (2009) Lymphovascular invasion in transurethral resection specimens as predictor of progression and metastasis in patients with newly diagnosed T1 bladder urothelial cancer. J Urol 182(6):2625–2630. doi:10.1016/j.juro.2009.08.083

    Article  PubMed  Google Scholar 

  6. Shariat SF, Svatek RS, Tilki D, Skinner E, Karakiewicz PI, Capitanio U, Bastian PJ, Volkmer BG, Kassouf W, Novara G, Fritsche HM, Izawa JI, Ficarra V, Lerner SP, Sagalowsky AI, Schoenberg MP, Kamat AM, Dinney CP, Lotan Y, Marberger MJ, Fradet Y (2010) International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int 105(10):1402–1412. doi:10.1111/j.1464-410X.2010.09217.x

    Article  PubMed  Google Scholar 

  7. Kunju LP, You L, Zhang Y, Daignault S, Montie JE, Lee CT (2008) Lymphovascular invasion of urothelial cancer in matched transurethral bladder tumor resection and radical cystectomy specimens. J Urol 180(5):1928–1932. doi:10.1016/j.juro.2008.07.056 Discussion 1932

    Article  PubMed  Google Scholar 

  8. Dalbagni G, Vora K, Kaag M, Cronin A, Bochner B, Donat SM, Herr HW (2009) Clinical outcome in a contemporary series of restaged patients with clinical T1 bladder cancer. Eur Urol 56(6):903–910. doi:10.1016/j.eururo.2009.07.005

    Article  PubMed  Google Scholar 

  9. Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Palou-Redorta J, Roupret M (2011) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 59(6):997–1008. doi:10.1016/j.eururo.2011.03.017

    Article  PubMed  Google Scholar 

  10. Joudi FN, Smith BJ, O’Donnell MA (2006) Final results from a national multicenter phase II trial of combination bacillus Calmette-Guerin plus interferon alpha-2B for reducing recurrence of superficial bladder cancer. Urol Oncol 24(4):344–348. doi:10.1016/j.urolonc.2005.11.026

    Article  PubMed  CAS  Google Scholar 

  11. Davidson RS, Nwogu CE, Brentjens MJ, Anderson TM (2001) The surgical management of pulmonary metastasis: current concepts. Surg Oncol 10(1–2):35–42

    Article  PubMed  CAS  Google Scholar 

  12. Siefker-Radtke AO, Walsh GL, Pisters LL, Shen Y, Swanson DA, Logothetis CJ, Millikan RE (2004) Is there a role for surgery in the management of metastatic urothelial cancer? The M. D. Anderson experience. J Urol 171(1):145–148. doi:10.1097/01.ju.0000099823.60465.e6

    Google Scholar 

  13. Cahan WG, Shah JP, Castro EB (1978) Benign solitary lung lesions in patients with cancer. Ann Surg 187(3):241–244

    Article  PubMed  CAS  Google Scholar 

  14. Padhani AR (2002) Dynamic contrast-enhanced MRI in clinical oncology: current status and future directions. J Magn Reson Imaging 16(4):407–422. doi:10.1002/jmri.10176

    Article  PubMed  Google Scholar 

  15. Tuncbilek N, Kaplan M, Altaner S, Atakan IH, Sut N, Inci O, Demir MK (2009) Value of dynamic contrast-enhanced MRI and correlation with tumor angiogenesis in bladder cancer. AJR Am J Roentgenol 192(4):949–955. doi:10.2214/AJR.08.1332

    Article  PubMed  Google Scholar 

  16. Kono R, Fujimoto K, Terasaki H, Muller NL, Kato S, Sadohara J, Hayabuchi N, Takamori S (2007) Dynamic MRI of solitary pulmonary nodules: comparison of enhancement patterns of malignant and benign small peripheral lung lesions. AJR Am J Roentgenol 188(1):26–36. doi:10.2214/AJR.05.1446

    Article  PubMed  Google Scholar 

  17. Mukhopadhyay S, Gal AA (2010) Granulomatous lung disease: an approach to the differential diagnosis. Arch Pathol Lab Med 134(5):667–690. doi:10.1043/1543-2165-134.5.667

    PubMed  Google Scholar 

  18. Lamm DL, van der Meijden PM, Morales A, Brosman SA, Catalona WJ, Herr HW, Soloway MS, Steg A, Debruyne FM (1992) Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol 147(3):596–600

    PubMed  CAS  Google Scholar 

  19. Kono Y, Endo S, Otani S, Saito N, Hasegawa T, Sato Y, Sohara Y (2005) Non-tuberculous mycobacterial infection along the staple-suture line after segmentectomy for small peripheral lung cancer; report of a case. Kyobu Geka 58(2):165–168 (in Japanese)

    PubMed  Google Scholar 

  20. Harada N (2006) Characteristics of a diagnostic method for tuberculosis infection based on whole blood interferon-gamma assay. Kekkaku 81(11):681–686 (in Japanese)

    PubMed  CAS  Google Scholar 

  21. Erasmus JJ, McAdams HP, Farrell MA, Patz EF Jr (1999) Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. Radiographics 19(6):1487–1505

    PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Urology, Gunma Prefectural Cancer Center, 617-1, Takabayashi-machi, Ota, Gunma, 373-8500, Japan

    Seiji Arai, Masaru Hasumi & Nobuaki Shimizu

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  1. Seiji Arai
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  2. Masaru Hasumi
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  3. Nobuaki Shimizu
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Correspondence to Seiji Arai.

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Arai, S., Hasumi, M. & Shimizu, N. Long-term survival and onset of granulomatous pneumonia after lung metastasectomy in a patient with non-muscle-invasive bladder cancer. Int Urol Nephrol 44, 1383–1387 (2012). https://doi.org/10.1007/s11255-012-0203-3

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  • DOI: https://doi.org/10.1007/s11255-012-0203-3

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