Rare Case of a Primary Neuroendocrine Small Cell Carcinoma of the Bladder


Video Presentation


1. Introduction
Bladder cancer in America is the fifth most common cancer diagnosis with greater than 76,000 new cases and over 16,000 deaths per year [1]. While most bladder cancers are diagnosed as transitional cell carcinoma, other cancers are also present [2,3]. Small cell carcinoma (SCC) makes up less than 1% of all bladder tumors. Prognosis is usually very poor due to the high metastatic rate. Due to the limited number of cases of SCC in the bladder, consensus on specific protocols for treatment has not been established.

2. Case Report
A 69-year-old white male was referred to us for a bladder biopsy positive for SCC. Patient had a past medical history significant for transitional cell carcinoma (TCC) of the bladder, elevated PSA, hypertension, COPD, coronary artery disease, diabetes, and a 45-pack year tobacco use history. Surgical history is significant for transurethral bladder tumor excision with fulguration, prostate biopsy, and coronary artery stents. Patient had been complaining of hematuria on and off for almost a year along with recurrent UTIs treated with fluoroquinolones. On most recent cystoscopy, a 5 cm tumor was spotted on the posterior wall of the bladder. Biopsy results came back showing SCC of the bladder with involvement of the lamina propria and muscularis propria of the detrusor muscle. Patient had a CT scan as well as a bone scan which were negative. A treatment plan consisting of cisplatin along with etoposide was prescribed along with a referral to surgery to determine if the patient was a good surgical candidate, otherwise radiation therapy may be used in lieu of cystectomy.

3. Discussion
Due to the aggressive nature of SCC, it is not surprising that more than 60% of patients reported to have SCC had metastatic lesions at the time of diagnosis [4]. It is also not uncommon to have a diagnosis of TCC along with SCC [5]. Due to the relative similarities seen with SCC and TCC on gross examination, they must be differentiated using histopathological analysis. Key immunohistochemical stains used to diagnose SCC are cytoplasmic chromogranin A, synaptophysin, and “dot like” cytokeratin (CK20) [5]. CT scan, bone scan and PET scans are used after diagnosing SCC of the bladder to check for metastasis due to the high metastatic rates with SCC. Typically for early stage SCC, transurethral resection or radical cystectomy is the first line treatment. When the cancer is more invasive involving the muscle or lymph nodes, a combination therapy of chemo and radiation is warranted.

4. Conclusion
SCC of the bladder is a very rare form of bladder cancer. The best course of action to go by from the limited cases seen shows that cystectomy along with chemotherapy is a good place to start treating the cancer. Further investigation needs to take place for other chemotherapeutic treatment options or immunotherapeutic treatments for SCC. With high rates of micrometastases in SCC, developing a method to slow down the micrometastases would be ideal in increasing the 1-year and 5-year survival rates.