ADVANCED INOPERABLE URINARY BLADDER ADENOCARCINOMA: A CASE REPORT

Aim: Primary urinary bladder adenocarcinoma is a rare entity. This is a clinical case presentation with review of the literature on this topic.  Primary adenocarcinoma of the urinary bladder has shown a poor response to radiation or chemotherapy individually. Therefore, combination chemotherapy with radical EBRT is the effective therapeutic approach for inoperable cases.

Method: A 58 year old male patient referred to the department of Radiotherapy, Regional Cancer Centre, Pt. BDS PGIMS ROHTAK with complaints of gross painless hematuria, dysuria, burning micturation for 5 years. Diagnostic work-up included renal and bladder ultrasound, cystoscopy and CT scan of abdomen and pelvis. CT scan showed mass lesion in urinary bladder infiltrating anterior abdominal wall (primary bladder adeno- carcinoma T4bN0M0). Trans-urethral resection followed by tissue diagnosis revealed an invasive adenocarcinoma. Metastatic disease was ruled out. Patient responded completely to systemic combination chemotherapy including GEMCITABINE and CARBOPLATIN six courses followed by radical external radiotherapy. At 24 months of follow-up, the patient did not present disease progression or systemic complications, after that he developed a nodular lump in neck. FNAC of node showed metastatic high grade carcinoma, for that he received palliative RT and six courses of CT with Paclitaxel, Cisplatin & Methotrexate, now patient is in complete response.

Conclusion: Primary bladder adenocarcinoma is rare. Unlike urothelial carcinoma, it responds poorly to chemotherapy or radiotherapy individually. Combination chemotherapy with Radical EBRT offers the best chance of long-term survival to those where surgery is not feasible.