Metastatic Pleural Effusion: An Unusual Presentation of Urothelial Bladder Carcinoma

Our plain-English summary of Metastatic Pleural Effusion: An Unusual Presentation of Urothelial Bladder Carcinoma, by I.N. Javed, T. Abdo, N. Ahmad, et al (Curēus, 2019).

The study

• Authors: I.N. Javed, T. Abdo, N. Ahmad, K.R. Jones
• Journal: Curēus
• Published: 2019;11(5):e4619
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural effusions are frequently encountered in clinical practice. In the United States, malignancy is the third leading cause of pleural effusion after heart failure and pneumonia. The most common cause of malignant pleural effusion (MPE) is lung cancer, followed by breast cancer, lymphoma, and mesothelioma. Genitourinary cancers rarely metastasize to the pleura. Although several atypical patterns of thoracic metastasis from genitourinary cancers have been described in the literature, genitourinary cancers rarely give rise to MPEs. We describe a case where the workup of a unilateral pleural effusion led to the diagnosis of high-grade urothelial bladder carcinoma.

In plain English

This article is a case report about one patient. It does not discuss asbestos; mesothelioma appears only in a list of common causes of cancerous fluid around the lungs. A 69-year-old man, described as a heavy smoker, came to an emergency department with worsening shortness of breath. A chest X-ray showed a large collection of fluid around the right lung (a pleural effusion), and draining it removed 1.5 liters of fluid. Within a week the fluid had returned. A CT scan showed thickening of the bladder wall. Tests on the drained fluid found cancer cells whose staining pattern was most consistent with urothelial carcinoma, a cancer of the bladder lining. Surgeons removed a 5-cm bladder tumor, and pathology confirmed invasive high-grade urothelial carcinoma. The fluid was drained again and treated with talc to stop it from returning. He was readmitted with worsening kidney injury and other complications, and he died on day 36 after his first visit. The authors concluded that spread of bladder cancer to the lining of the lung is unusual and that only a few cases have been reported.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 69-year-old man, a heavy smoker, seen in an emergency department for worsening shortness of breath. The authors work at hospitals in Oklahoma, USA. No dates are given.
• Exposure: No asbestos or other occupational exposure is mentioned. The patient is described only as a heavy smoker.
• Main results:
  • Draining the right-sided pleural effusion with a needle removed 1.5 liters of turbid orange fluid.
  • Within a week the patient returned to the emergency department with the right-sided pleural effusion back.
  • A CT scan of the abdomen and pelvis showed bladder wall thickening that raised concern for a bladder tumor.
  • The pleural fluid contained malignant cells. Their staining profile (CK7, CK20 and GATA-3 positive) was most consistent with urothelial carcinoma.
  • A 5-cm papillary bladder tumor was removed. Pathology confirmed invasive high-grade urothelial carcinoma invading the lamina propria.
  • A pleural catheter was placed and talc pleurodesis was performed to prevent the fluid from returning.
  • The patient had a LENT prognostic score of 3, which the authors describe as moderate risk.
  • The patient died on day 36 after his first presentation.
• The authors' conclusion: The authors concluded that this was an unusual spread of urothelial carcinoma to the pleura, with only a few reported cases, and that metastatic bladder cancer should be considered in atypical presentations.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Carcinoma, Lung Cancer, Mesothelioma, Metastasis, Pleura.

Related studies

• Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma — C. Basatac, F. Aktepe, et al. (2019)
• Cytomorphologic features of metastatic urothelial carcinoma in serous effusions — C.C. Huang, A. Attele, et al. (2013)
• "Cannonballs" and psammoma bodies: unusual cytologic features of metastatic pulmonary small-cell carcinoma in a pleural effusion — A.B. Conway, M.K. Hart, et al. (2013)
• Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma — A. Serao, F. Ambrosini, et al. (2022)
• Pleural Small Cell Lung Carcinoma: An Unusual Culprit in Pleural Effusion — O.D. Adejorin, A. Sodhi, et al. (2015)
• Utility of cytokeratin 20 in identifying the origin of metastatic carcinomas in effusions — V. Ascoli, S. Taccogna, et al. (1995)

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