Bladder cancer with cutaneous metastasis is a rare manifestation of the advanced stage of the disease. It can result from direct invasion, lymphatic or hematogenous spread, or iatrogenic implantation. We present a case of a 67-year-old patient initially diagnosed with urothelial carcinoma (UC) in situ of the bladder, who underwent transurethral resection of bladder tumor, along with induction and maintenance Bacillus Calmette-Guerin immunotherapy. Six years post-diagnosis, the patient developed multiple ulcerating fungating lesions in the right lower extremity, confirmed as metastases from UC. The patient additionally developed right foot gangrene with subsequent infection, which progressed into sepsis and caused the patient\'s demise.

We report the case of an 87-year-old woman with upper tract urothelial carcinoma at the left renal pelvis. She received stereotactic body radiotherapy of 35 Gy in five fractions for palliative treatment of hematuria that was delivered by a 1.5-T magnetic resonance (MR) imaging-guided linear accelerator. Her symptom was relieved after treatment, and posttreatment imaging revealed a complete response of the primary tumor. Thus, this case showed that stereotactic MR-guided radiotherapy could be an appealing option for inoperable patients although radiotherapy is infrequently mentioned in the current treatment guideline of upper tract urothelial carcinoma. Daily adaptive planning from MR images obtained before treatment could improve the target dose and minimize the organ at risk dose. This may lead to a decrease in radiation adverse effects including worsening renal function due to the renal pelvis tumor\'s proximity to the kidney.

Pulmonary osseous metaplasia is a disease in which mature bone is found within the parenchyma of the lung. The current study presents a case of pulmonary osseous metaplasia in a 64-year-old female. The patient was previously diagnosed with transitional cell carcinoma (TCC) of the lower ureter. During a routine check-up, an enhancing basal lung nodule was found on chest computed tomography scan, which was suspected to be metastatic lung disease. The patient underwent a thoracoscopic resection of the nodule. The histopathological examination of the specimen confirmed it to be myeloid osseous metaplasia. The disease usually has no significant complications and can also be found in association with other pulmonary diseases. Very limited information is available on the phenomenon; therefore, there is no exact treatment guide for clinicians to follow. In conclusion, myeloid osseous metaplasia of the lung is a rare finding, and based on this report, it may be associated with TCC.

Transitional cell carcinoma (TCC) of the ovary is a rare subtype of epithelial ovarian tumours defined as a tumour composed of epithelial elements, histologically resembling urothelium and its neoplasms. Ovarian metastases from primary urinary tract carcinomas are rare. The differential diagnosis of primary TCC of the ovary versus metastatic bladder TCC is challenging because of histological similarity. We present the case of a 49-year-old premenopausal woman who was initially diagnosed with non-invasive papillary urothelial carcinoma of bladder (NIPUC) and after 2 years with a synchronous TCC of the ovary while being investigated for suspected relapse. She underwent a radical cystectomy, total hysterectomy, bilateral salpingo-oopharectomy, and pelvic lymph node dissection. The final diagnosis of synchronous NIPUC of the bladder and TCC of the ovary was made by histopathology and immunohistochemical studies.

Zosteriform cutaneous metastases from urothelial carcinoma are rare. Here, we report a 50-year-old male with urothelial carcinoma who presented with multiple tender, erythematous papulonodules in an L1-L3 distribution approximately 6 years after primary tumor diagnosis. He had no history of prior herpes zoster infection. Histopathology showed lobules and small nests of atypical epithelioid cells positive for GATA3, CK20, CK7, and p40 throughout the dermis and within lymphatic vessels highlighted by D2-40, consistent with cutaneous metastases from urothelial carcinoma. No perineural invasion or viral cytopathic change was present. The patient died approximately 8 months after diagnosis of cutaneous metastases. Since its first report in 1986, there have been only six cases of zosteriform cutaneous metastases from urothelial carcinoma. We review the prior literature including hypotheses of the pathogenesis of zosteriform cutaneous metastases, which remain incompletely understood.

We present the case of a 73-year-old woman who was incidentally found to have a malignant Brenner tumor (MBT) of the ovary during an evaluation for deep vein thrombosis (DVT). The patient presented with swelling in her left leg, non-healing ulcers, weakness, and numbness in her lower limbs. Imaging studies revealed a large multiloculated cystic mass with areas of calcification in the left adnexa extending to the upper abdomen toward the gallbladder fossa. The patient underwent exploratory laparotomy with removal of the ovarian cyst, later diagnosed as a focal MBT in a background of borderline Brenner tumor. Brenner tumors of the ovary are a rare subtype of ovarian neoplasm that accounts for less than 2% of all ovarian tumors. MBTs are even rarer, comprising less than 5% of all Brenner tumors. To our knowledge, this is the first reported case of an MBT incidentally found in a patient with DVT.

Metastasis to the supraclavicular lymph nodes usually originate from primary tumours in the head and neck, breast or abdomen. Infradiaphragmatic tumours very rarely metastasise to these nodes. Transitional cell carcinomas (TCCs), also termed urothelial carcinomas, account for ⁓90% of all ureteral cancers; exceptionally few cases have reported such cancers spreading to the supraclavicular fossae. We present the case of a 65-year-old male who was being investigated for gallstones and was subsequently found to have metastatic bony lesions and widespread adenopathy on magnetic resonance cholangiopancreatography. Initially, the primary cancer was an area of contention between clinicians, as radiologists suggested it was of urological origin, but the bladder multidisciplinary team felt the scans did not fulfil this notion. Ultimately, histological analysis confirmed the diagnosis of metastatic TCC.

This paper presents a case report of plasmacytoid variant urothelial carcinoma (PVUC), a rare form of transitional cell carcinoma. PVUC is known for its unique clinical features, aggressive behavior, and poor survival rates. PVUC comprises less than 3% of all bladder tumors, and its diagnosis is often difficult due to its resemblance to other forms of bladder cancer. It requires a staging workup to rule out metastasis, relies heavily on immunostaining and histopathological analysis for diagnosis, and requires a multidisciplinary approach with early aggressive treatment, including cisplatin-based chemotherapy following surgery. This report highlights the importance of understanding rare variants of bladder cancer to ensure timely and accurate diagnosis and appropriate treatment planning. We report here a case of a 75-year-old male with multiple comorbidities who presented with hematuria and was diagnosed with urothelial carcinoma plasmacytoid type, which was initially treated with transurethral resection but later found to be unresectable and treated with palliative chemotherapy and radiation therapy. Eventually, the patient passed away three years after the diagnosis.

Bladder cancer is considered the most prevalent malignancy affecting the urinary tract system. Urothelial carcinoma, also known as transitional cell carcinoma (TCC), can arise from the entire urinary tract, with the bladder considered the primary site of origin and representing 95% of all cases. The management of TCC of the upper urinary tract is mainly by nephroureterectomy (NU). To our knowledge, there are no data regarding single-docking robotic-assisted NU following cystectomy with an ileal conduit. Therefore, in this study, we are reporting a case of single-docking robotic-assisted NU in a patient who previously underwent open cystectomy with an ileal conduit. A case of a 57-year-old female diagnosed with bladder cancer 10 years ago and underwent several transurethral resections of bladder tumor (TURBT) sessions presented for the first time in 2019, complaining of hematuria and dropping in the hemoglobin, which was not improving with multiple TURBT. For that, the patient underwent an open radical cystectomy with an ileal conduit. During the follow-up in 2021, computed tomography (CT) of the pelvis and abdomen with intravenous (IV) contrast showed a 7 mm enhancing lesion in the right proximal ureter, which was suspicious of proximal ureter mass. In 2022, the patient was again seen in the outpatient clinic; a CT of the pelvis and abdomen with IV contrast was done and demonstrated a significant progression of the mass size to 2 x 1.5 cm, with no other intraabdominal or intrathoracic lesions. For that, she underwent a single-docking robotic-assisted NU. To conclude, performing a single-docking robotic-assisted NU in a patient who previously underwent open radical cystectomy with an ileal conduit is challenging due to multiple adhesion and altered anatomy. More studies need to be published regarding the long-term outcomes of such procedures.

Brain metastases are the most common type of brain tumor in adults, commonly arising from primary tumor sites of the lung, breast, skin (melanoma), colon, and kidney. Isolated central nervous system (CNS) metastasis arising from urothelial carcinoma (UC) is a rare presentation yielding a poor prognosis. A 71-year-old male patient with a history of urothelial carcinoma, treated one year prior with partial cystectomy and adjuvant gemcitabine and cisplatin (GC) therapy, presented with worsening neurological symptoms, including progressively worsening dizziness, shuffling gait, drifting, expressive aphasia, and confusion. MRI revealed a left frontal 4.0 x 3.6 cm brightly contrast-enhancing tumor with possible hemorrhage, extensive vasogenic edema, and moderate mass effect. An additional smaller right cerebellar lesion was also noted. Outpatient CT of his chest, abdomen, and pelvis revealed no evidence of other malignant sites. He ultimately underwent a left craniotomy with a total resection of his left frontal mass. Pathological examination revealed a urothelial primary. Post-operative MRI revealed complete resection of the left frontal mass and the patient was discharged with no neurologic deficits on exam. In many cases, brain metastases may present years later following initial therapy of UC as the CNS may act as a sanctuary site during systemic chemotherapy. Chemotherapeutics such as gemcitabine with better penetration of the blood-brain barrier may be beneficial in delaying the onset of these metastases.