Primary squamous cell carcinoma of urinary bladder is a rare disease variant, accounting for less than 5% of all primary bladder cancers . The diagnosis of bscc is based on criteria established by the World Health Organization classification system  and it is a poorly differentiated tumor, it usually progresses rapidly and it characterizes by a worse prognosis than the most frequently represented bladder carcinoma, the urothelial carcinoma (UC) . We report an unusual episode of a patient with squamous cell carcinoma of urinary bladder and contemporary adenocarcinoma of the descending colon asymptomatic, discovered in stages of staging and subsequently of hepatic metastases from colon adenocarcinoma. the patient underwent radical surgical therapy, ureterocutaneostomy and later chemiotherapy for metastases
The case report we are talking about concerns a 74-year-old patient, woman, who came to our attention for recurrent hematuria episodes, for several months (maybe eighteen), which have been treated with empirical antibiotic therapy (by general practitioner) without, however, investigate further with at least a radiological examination. After first stadiative investigations, the patient was diagnosed with a primary squamous bladder and a metacronous colon adenocarcinoma too, completely asymptomatic, so considered as an incidentaloma in the radiological diagnosis of staging.
The complete diagnosis was obtained by ultrasound, cystoscopy, trans urethral bladder resection, colonoscopy with biopsy and PET / CT (by usingfluoro-deoxyglucoseas radiopharmaceutical).
In 2017 the patient underwent transurethral resection of bladder cancer (TURBT) at our institution; the histological diagnosis elaborated was “Solid urothelial carcinoma (G3), with marked squamous differentiation infiltrating also the muscular tunic present”.
Subsequently the patient was subjected to a stadiative PET/CT, which showed presence of a descending colon circular neoformation. The patient was then subjected to a colonoscopy [Image 1], which confirmed the PET/CT (F-18 + FDG) suspected diagnosis, finding a circular lumen stenosing and ulcerated lesion, 40 cm away from the anal margin, and the lesion did not allow flexible endoscope further transit. Moreover, thanks to sub optimal intestinal cleansing (Boston Score = 3, as the other two traits score were not assigned), it was possible to appreciate the presence of a pedunculated polyp (size 8mm), 10 cm away from the anal margin, despite the numerous and persistent diffuse intestinal musculature’s spasms. During endoscopy, several biopsy samples were taken by the descending colon stenosing lesion, and the histological examination (in GB staining) revealed as outcome adenocarcinoma tissue.
In January 2018 the patient underwent radical cystectomy with ureterocutaneostomy, partial colon resection with termino-terminal anastomosis, left lymphandenectomy and enlarged hysterectomy with partial vaginectomy.
The histological report of the surgical specimen confirmed transurethral resection (TURBT) previous report: “solid urothelial carcinoma (G3) with marked squamous differentiation with muscular tunic infiltration”.
Colon resection showed the presence of adenocarcinoma, the surgical resection margin was negative.
No infiltration of tumor cells was found in the uterus, in the excised appendages, in the anterior wall of the vagina and no involvement of the nearby nodes was detected.
The patient performed both PET / CT (F-18 + FDG) and abdomen ultrasound six-month follow-ups.
In February 2019, PET / CT (F-18 + FDG) detected, in the liver, altered glucose metabolism in some areas as VII (SUV max 5.31), VIII (SUV max 11.5 vs 3.91 previous PET control on 07/05/2018), III segment (SUV max 11.6) and in VI segment (SUV max 6.92) [Image 2 – 3].
The remaining examined body areas were negative, within the methodic’s limits.
In March 2019, the patient underwent liver lesions’ biopsy, shown by the PET/CT (F-18 FDG) last February, which confirmed the presence of liver metastases, of intestinal origin, with adenocarcinoma metastasis’ characters.
Since May 2019 She has undergone chemotherapy cycles, with Folfox protocol (5-fluoro-uracil, folinic acid, oxaliplatin), currently the patient is still receiving therapy (with poor performance status and poor compliance) and she is monitored with general follow-ups.
The patient after the surgical phase had a recovery without complications. The management of ureterocutaneostomy was home-based and all tests were negative until the appearance of asymptomatic liver metastases.
The patient had a long disease-free duration after radical surgery. The presentation of hepatic metastases observed in our case was an event that emerged in the less-awaited follow-up compared to the possibility of local secondary or recurrence that we would have expected from the squamous cell carcinoma of urinary bladder.
1. Sunil V.J., J Clin Diagn Res. Primary Squamous Cell Carcinoma of Urinary Bladder – A Rare Histological Variant. Epub, 2015.
2. J. N. Eble, WHO Classification of the Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs, IARC Press lon, France, 2004.
3. Tavora F, Epstein JI. Bladder cancer, pathological classification and staging. BJU International.2008.