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A 61-year-old otherwise healthy man is referred for evaluation of hematuria. A computed tomography urogram reveals a tumor on left lateral wall of the bladder, and the patient undergoes an uneventful transurethral resection.
Pathology reveals high-grade urothelial carcinoma with micropapillary features invading the lamina propria (T1). Muscularis propria is present and is uninvolved.
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Answer: Strong consideration of immediate cystoprostatectomy and urinary diversion
Micropapillary disease is an extremely aggressive variant of urothelial carcinoma. The disease does not respond to intravesical agents. Furthermore, T1 carcinoma appears to be just as lethal as T2 muscle-invasive disease. It has been suggested that neoadjuvant therapy is not effective. As such, immediate cystectomy is highly advisable in patients who are appropriate surgical candicates.1, 2
References
- Canter D, Simhan J, Smaldone MC, et al. Clinical stage T1 micropapillary urothelial carcinoma presenting with metastasis to the pancreas. Urology 2012;79:e9-e10.
- Kamat AM, Dinney CP, Gee JR, et al. Micropapillary bladder cancer: a review of the University of Texas M. D. Anderson Cancer Center experience with 100 consecutive patients. Cancer 2007;110:62-67.
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