|Year : 2006 | Volume
| Issue : 4 | Page : 372-373
Squamous cell carcinoma of the oral cavity with metastasis to the urinary bladder
Tanmaya Goel1, Sreedhar Reddy1, Joseph Thomas1, Shveta Garg2
1 Department of Urology, Kasturba Medical College (KMC), Manipal, India
2 Department of Pathology, Kasturba Medical College (KMC), Manipal, India
Department of Urology, Kasturba Medical College (KMC), Manipal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Squamous cell carcinoma (SCC) of the oral cavity with metastasis to the urinary bladder is an unreported phenomenon. There are a few reports of transitional cell carcinoma of the bladder metastasizing to the oral cavity, though very rare. Thus, the possibility should always be borne in mind.
Keywords: Metastasis, oral cavity, squamous cell carcinoma, urinary bladder
|How to cite this article:|
Goel T, Reddy S, Thomas J, Garg S. Squamous cell carcinoma of the oral cavity with metastasis to the urinary bladder. Indian J Urol 2006;22:372-3
| Introduction|| |
Transitional cell carcinoma (TCC) is the commonest bladder malignancy. Squamous cell carcinoma (SCC) of the bladder in itself is rare and that as a metastasis from the oral cavity is not reported till today to the best of our knowledge. Herein, we bring forth a case to create awareness amongst the medical fraternity.
| Case report|| |
A 64-year-old male patient, chronic smoker, presented to the dental clinic with complaints of pain on chewing and excessive salivation with halitosis and occasional blood-tinged saliva for over two years. He was evaluated and diagnosed to have a mass lesion in the right retromolar trigone. A biopsy was done and he was diagnosed as having an advanced high-grade SCC. He was advised surgery, but the patient declined due to financial constraints, hence was subjected to radiotherapy.
For the last six months, patient started complaining of progressive dysuria, increased frequency, urgency and two episodes of self-limiting, total painless hematuria with small amorphous clots. He consulted a local practitioner who advised an ultrasound study to rule out prostatic enlargement. Ultrasonography revealed a prostate of normal echo texture, 46 ml in volume. The bladder wall was thickened. There was a mixed echogenic - broad based growth approx. 6 cm by 7 cm with surface calcification, situated on the left posterolateral wall. The kidneys were normal in size, shape and echo with mild left hydroureteronephrosis noted till the bladder.
Contrast enhanced computerized tomography scan of the abdomen and pelvis was done and that confirmed the sonological findings [Figure - 1]. The urine cytology for malignant cells was negative. The patient underwent transurethral resection of the tumor. Histopathology came as muscle invasive SCC [Figure - 2]. The patient was planned for radical cystectomy and urinary diversion, but again the patient and his relatives refused surgery. He was initiated on chemoradiation. The patient developed extensive pulmonary metastasis in the follow-up period and expired in five months.
| Discussion|| |
SCC of the oral cavity and urinary bladder occurring in the same patient are an undescribed entity. Whether it is metastasis from the oral cavity to the bladder or a part of the field change associated to smoking is not ascertainable with conviction. But, going by the chronology of symptomology (oral tumor presenting two years ago with no urinary symptoms then), it can safely be deduced that this patient presented with metastasis to the urinary bladder from the oral cavity. The patient apart from a history of smoking had no predisposing factors for a bladder tumor - history of vesical calculus, diverticulum, long-term catheterization etc. that could point to a primary SCC of the bladder. Being an aggressive tumor, primary SCC of the bladder would have manifested much earlier in the patient's lifetime.
Molecular profiling using tissue cDNA microarrays and immunohistochemistry can be used to differentiate a primary SCC from metastasis. Keratin 10 and caveolin-1 are more abundant in tumor cells from primary SCC of the bladder and not from the oral cavity. The molecular alterations like HRAS mutations, EGFR over expression and HER2 expression are typical of urothelial malignancies and not of the oral cavity. There are reports of transitional cell carcinoma of the bladder metastasizing to the oral cavity, especially to the mandible and gingiva or an isolated report of SCC in a bladder diverticulum with metastasis to the maxillary antrum.
Thus, this rare condition should be borne in mind while dealing with SCC of the oral cavity and the urinary bladder.
| References|| |
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[Figure - 1], [Figure - 2]