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INTERESTING IMAGE
Year : 2020  |  Volume : 35  |  Issue : 3  |  Page : 251-252  

18F-fluorodeoxyglucose positron emission Tomography–Computed tomography in the evaluation of unusual cutaneous manifestation of carcinoma urinary bladder


Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission16-Mar-2020
Date of Acceptance23-Mar-2020
Date of Web Publication01-Jul-2020

Correspondence Address:
Dr. Ram Kumar Elumalai
Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi - 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_48_20

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   Abstract 


Bladder cancer is one of the most common malignancies of the urinary tract. Cutaneous metastasis of bladder carcinoma is extremely rare with a limited number of cases, resulting mainly from iatrogenic seeding. Here, we present scan findings of cutaneous metastasis in a known case of carcinoma urinary bladder. The 18F FDG PET/CT scan revealed FDG avid nodular thickening of the skin and sub-cutaneous tissue with ulcerations involving anterior pelvic wall, walls of the scrotum and the base of the penis. Histopathology confirmed the diagnosis of cutaneous and subcutaneous metastasis.

Keywords: 18F-fluorodeoxyglucose positron emission tomography–computed tomography scan, carcinoma urinary bladder, cutaneous metastasis


How to cite this article:
Elumalai RK, Gupta N, Verma R, Belho ES. 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography in the evaluation of unusual cutaneous manifestation of carcinoma urinary bladder. Indian J Nucl Med 2020;35:251-2

How to cite this URL:
Elumalai RK, Gupta N, Verma R, Belho ES. 18F-fluorodeoxyglucose positron emission Tomography–Computed tomography in the evaluation of unusual cutaneous manifestation of carcinoma urinary bladder. Indian J Nucl Med [serial online] 2020 [cited 2020 Aug 9];35:251-2. Available from: http://www.ijnm.in/text.asp?2020/35/3/251/288465



A 62-year-old male patient, a known case of metastatic carcinoma urinary bladder with multiple skeletal metastases, posttransurethral resection of bladder tumor, radiotherapy to pelvis, and multiple cycles of chemotherapy, was referred for 18 F-fluorodeoxyglucose positron emission tomography–computed tomography (18 F-FDG PET-CT) scan. MIP [Figure 1]a image of the whole-body 18 F-FDG PET/CT scan showed multiple FDG avid lesions. The corresponding axial images showed multiple mildly FDG avid and non-FDG avid osteolytic skeletal lesions, which showed no significant interval change as compared to previous scan. FDG avid expansile osteolytic lesion with associated soft tissue component [Figure 1]b, [Figure 1]c, [Figure 1]d localized in the right 11th rib posteriorly and FDG avid nodular thickening of the cutaneous and subcutaneous tissue with ulcerations involving anterior pelvic wall, walls of the scrotum, and the base of the penis [Figure 1]e, [Figure 1]f, [Figure 1]g, [Figure 1]h, [Figure 1]i, [Figure 1]j were the new findings in the scan. The FDG avid cutaneous and subcutaneous lesions were suspicious for metastasis, with differential diagnosis being radiation-induced ulcer in view of history of the radiotherapy to the pelvic region. Histopathology from punch biopsy of the ulcerative lesion from the base of penis demonstrated features of nuclear atypia and lymphovascular emboli, confirming the diagnosis of dermal carcinoma deposit from the primary urinary bladder cancer.
Figure 1: MIP (a) of the whole-body 18F-fluorodeoxyglucose positron emission tomography–computed tomography scan showing multiple metastatic lesions. The corresponding axial fused positron emission tomography–computed tomography (b), computed tomography (c), and positron emission tomography (d) images showing fluorodeoxyglucose avid expansile osteolytic lesion in right 11th rib. Axial fused positron emission tomography–computed tomography, computed tomography, and positron emission tomography (e-j) images showing fluorodeoxyglucose uptake in the nodular thickening of the skin and subcutaneous tissue with ulcerations involving the walls of scrotum, base of the penis, and anterior pelvic wall

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Bladder cancer is one of the most common malignancies of the urinary tract. It is the fourth most common cancer in males and the tenth most common cancer in females. Urinary bladder cancer occurs three to four times more frequently in men than in women.[1] Urothelial carcinoma accounts for 90% of cases of bladder cancer in Western countries, and squamous cell carcinoma is the most common bladder cancer in Eastern Africa and the Middle East, where schistosomiasis is prevalent.[2] Cutaneous metastasis of bladder carcinoma is extremely rare with a limited number of cases, resulting mainly from iatrogenic seeding reported to date.[3] Otherwise, primary cutaneous metastasis of transitional cell carcinoma is accepted as the late manifestation of systemic spread.[4],[5] The incidence is reported to be <1% and ranges from 0.18% to 2% for cancer of the urinary bladder.[6] The usefulness of 18 F FDG-PET CT in the evaluation of bladder cancer is limited to the evaluation of distant metastases.[7],[8] This is due to the reason that the interpretation of 18 F-FDG PET images is difficult because of urinary excretion of this radiotracer, which accumulates in the urinary system and may mask pathologic deposits in malignant lesions. According to our knowledge, few case series of cutaneous metastasis from visceral organs [9] and very few case reports of cutaneous metastasis from carcinoma urinary bladder were reported in the literature. The first recorded case of cutaneous metastasis from carcinoma urinary bladder was in 1909. The latest case of cutaneous metastasis from carcinoma urinary bladder was reported in 2015.[10]

Here, we report an interesting case of rare findings of cutaneous metastasis involving anterior pelvic wall, walls of the scrotum, and base of the penis, diagnosed after 8 years of diagnosis of primary urinary bladder carcinoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Elston DM, Tuthill RJ, Pierson J, Marden JD, Bergfeld WF. Carcinoma erysipelatoides resulting from genitourinary cancer. J Am Acad Dermatol 1996;35:993-5.  Back to cited text no. 4
    
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Messing EM, Catalona W. Urothelial tumors of the urinary tract. Bladder cancer. In: Walsh PC, Retik AB, Vaughan ED Jr., Wein AJ, editors. Campbell's Urology, 7th ed. Philadelphia: W.B. Saunders Co.; 1998. p. 2329-83.  Back to cited text no. 5
    
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Fujita K, Sakamoto Y, Fujime M, Kitagawa R. Two cases of inflammatory skin metastasis from transitional cell carcinoma of the urinary bladder. Urol Int 1994;53:114-6.  Back to cited text no. 6
    
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Kumar R, Zhuang H, Alavi A. PET in the management of urologic malignancies. Radiol Clin North Am 2004;42:1141-53, ix.  Back to cited text no. 7
    
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Schöder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med 2004;34:274-92.  Back to cited text no. 8
    
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Gupta N, Malik D, Verma R, Belho ES, Manocha A. cutaneous metastasis from visceral organs: (18) F-Fluorodeoxyglucose positron emission tomography-computed tomography scan aiding in localizing primary site. Indian J Nucl Med 2019;34:205-8.  Back to cited text no. 9
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10.
Lees AN. Cutaneous metastasis of transitional cell carcinoma of the urinary bladder eight years after the primary: A case report. J Med Case Rep 2015;9:102.  Back to cited text no. 10
    


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