PDF(Pubmed)
Abstract：
Bone metastasis in urothelial cancer is underreported and not well-researched. A case of urothelial carcinoma (UC) with bone metastasis presenting as musculoskeletal pain is reported. The patient presented with persistent lower back pain associated with right lower extremity pain, numbness, and tingling. Initially, a diagnosis of sciatica was suspected, but the patient did not respond to treatment. An MRI spine was done, which revealed a bright signal mass in the vertebral body suspicious for a metastatic lesion, left hydroureteronephrosis, and a nonspecific cystic focus in the right iliacus muscle. Subsequent imaging revealed an irregular soft tissue mass at the left posterolateral bladder base, resulting in apparent obstruction of the left ureter, highly suggestive of neoplasm, along with numerous lytic bone lesions in the pelvic girdle with associated soft tissue masses, consistent with metastatic disease. The patient underwent an interventional radiology biopsy of the right iliac soft tissue mass to evaluate the lytic bony lesions, which revealed metastatic carcinoma, consistent with UC. A prompt referral was made for urology and oncology consultations. The patient underwent left percutaneous nephrostomy placement for obstruction, but he was not a candidate for any systemic therapy because of his poor performance status, and hospice was recommended as his metastatic disease was not curable and the goal of any kind of treatment was palliative. The optimal treatment for UC with bone metastasis remains divergent, and the management options should be determined as part of a shared decision-making process. This case highlights the importance of having a high suspicion of neoplastic pathology in patients presenting with musculoskeletal pain, like back pain, and not responding to treatment. This should alert the physicians to the potential for serious disease processes.
摘要：
尿路上皮癌中的骨转移报道不足，研究不充分。据报道，一例尿路上皮癌（UC）伴骨转移，表现为肌肉骨骼疼痛。患者表现为持续的下背部疼痛与右下肢疼痛相关，麻木,还有刺痛.最初，怀疑有坐骨神经痛的诊断,但患者对治疗没有反应。做了脊柱MRI检查,显示椎体中有一个明亮的信号团，怀疑是转移灶，左输尿管肾积水,右髂肌有一个非特异性囊性病灶.随后的成像显示膀胱左后外侧基底有一个不规则的软组织肿块，导致左输尿管明显阻塞，高度怀疑肿瘤，伴随着骨盆带中的许多溶解性骨病变以及相关的软组织肿块，与转移性疾病一致。患者接受了右髂软组织肿块的介入放射活检，以评估溶解性骨病变，揭示了转移性癌，与UC一致。及时转诊泌尿外科和肿瘤学会诊。患者因梗阻接受了左经皮肾穿刺造口术，但是由于他的表现不佳，他不是任何系统治疗的候选人，由于他的转移性疾病无法治愈，任何治疗的目标都是姑息治疗，因此建议接受临终关怀。UC骨转移的最佳治疗方法仍然存在分歧，管理选项应作为共享决策过程的一部分来确定。该病例强调了对肌肉骨骼疼痛患者高度怀疑肿瘤病理学的重要性，像背痛，对治疗没有反应。这应该提醒医生注意严重疾病过程的可能性。
