Metastatic Urothelial Carcinoma with Glandular Differentiation That Confirmed the Response by Autopsy Specimen to Second-Line mFOLFOX6 (Fluorouracil, Oxaliplatin, and Leucovorin) plus Bevacizumab Chemotherapy

The prognostic significance of glandular differentiation in urothelial carcinoma (UC) is controversial, and thus far there is no established treatment strategy against metastasis of glandular component. We describe here a case of metastatic UC with glandular differentiation that had histological dis...

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Published in:Case reports in oncology 2017-11, Vol.10 (3), p.1057-1064
Main Authors: Naiki, Taku, Etani, Toshiki, Naiki-Ito, Aya, Fujii, Kana, Ando, Ryosuke, Iida, Keitaro, Nagai, Takashi, Sugiyama, Yosuke, Nakagawa, Motoo, Kawai, Noriyasu, Yasui, Takahiro
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Language:English
Subjects:
Abdomen
Acids
Bladder
Bladder cancer
Case Report
Case reports
Chemotherapy
Immunotherapy
Liver
Medical imaging
Metastasis
mFOLFOX6 plus bevacizumab chemotherapy
Monoclonal antibodies
NMR
Nuclear magnetic resonance
Pathology
Targeted cancer therapy
University graduates
Urology
Urothelial carcinoma with glandular differentiation
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Nakagawa, Motoo
Kawai, Noriyasu
Yasui, Takahiro
description The prognostic significance of glandular differentiation in urothelial carcinoma (UC) is controversial, and thus far there is no established treatment strategy against metastasis of glandular component. We describe here a case of metastatic UC with glandular differentiation that had histological disappearance of adenocarcinoma components at autopsy after sequential chemotherapy with S-1 and cisplatin (CDDP) and with mFOLFOX6 (fluorouracil, oxaliplatin, and leucovorin) plus bevacizumab (mFOLFOX6+Bev). A 62-year-old Asian male was diagnosed with invasive UC with glandular differentiation (T2N0M0) by radical cystectomy and ileal conduit, and careful follow-up observation was made. Eight years after radical operation, peritoneal metastases occurred, and a biopsy specimen using colon fiber revealed high-grade adenocarcinomas with an immunohistochemical profile that included positivity for cytokeratin 7 (CK7) and negativity for cytokeratin 20 (CK20) and uroplakin, which was identical to the radical cystectomy specimen. Thus, he received combination chemotherapy consisting of S-1 and CDDP; however, the peritoneal metastasis worsened after 2 cycles. Therefore, second-line mFOLFOX6+Bev chemotherapy was performed for a total of 5 courses. In spite of this, the patient died, and the final diagnosis by autopsy was multiple metastases of infiltrating pure UC to the lung, bone, and peritoneum. Interestingly, there were no pathological findings of adenocarcinoma, and the immunohistochemical profile of the metastatic lesions was identical to that of the previous specimens from the bladder and colon. This suggests that sequential chemotherapy of S-1 and CDDP and second-line mFOLFOX6+Bev might be a feasible option in metastatic UC with glandular differentiation.
doi_str_mv 10.1159/000484597
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subjects Abdomen
Acids
Bladder
Bladder cancer
Case Report
Case reports
Chemotherapy
Immunotherapy
Liver
Medical imaging
Metastasis
mFOLFOX6 plus bevacizumab chemotherapy
Monoclonal antibodies
NMR
Nuclear magnetic resonance
Pathology
Targeted cancer therapy
University graduates
Urology
Urothelial carcinoma with glandular differentiation
title Metastatic Urothelial Carcinoma with Glandular Differentiation That Confirmed the Response by Autopsy Specimen to Second-Line mFOLFOX6 (Fluorouracil, Oxaliplatin, and Leucovorin) plus Bevacizumab Chemotherapy
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