Urothelial Carcinoma Recurrence With an Ileal Conduit: Multimodal Management With Extirpative Surgery, Chemotherapy, and Immunotherapy

Ileal conduit (IC) is the most performed urinary diversion after radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder. While UC recurrence after RC is well-described, recurrence of UC within a urinary diversion is much less prevalent, and thus, management of these lesions is not well...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-12, Vol.15 (12), p.e51157
Main Authors: Thakker, Parth U, Refugia, Justin, Sandberg, Maxwell, Rodriguez, Alejandro R, Hemal, Ashok K
Format: Article
Language:English
Subjects:
Anemia
Bladder
Cancer
Case reports
Cellular biology
Chemotherapy
Endoscopy
Hematuria
Immunotherapy
Medical prognosis
Metastasis
Monoclonal antibodies
Pathology
Patients
Surveillance
Targeted cancer therapy
Tomography
Transplants & implants
Urogenital system
Urological cancer
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Summary:Ileal conduit (IC) is the most performed urinary diversion after radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder. While UC recurrence after RC is well-described, recurrence of UC within a urinary diversion is much less prevalent, and thus, management of these lesions is not well understood. Here, we report the case of a 59-year-old male with a history of invasive UC with glandular differentiation of the urinary bladder who had carcinoma in situ recurrence after induction, intravesical Bacille Calmette-Guerin therapy. He underwent robot-assisted laparoscopic radical cystoprostatectomy (RALC) with bilateral pelvic lymph node dissection and intracorporal ileal conduit (IC) urinary diversion. Two years later, he presented to the emergency department with hematuria. Computed tomography demonstrated a mass within the IC. He subsequently underwent IC resection and ligation of bilateral ureters and had permanent nephrostomy tubes placed, with the final pathology confirming high-grade UC. Positron emission tomography revealed hypermetabolic soft tissue implants within the greater omentum and retroperitoneum for which he underwent fine-needle aspiration, demonstrating recurrence of poorly differentiated UC. Ultimately, the patient started treatment with systemic gemcitabine and carboplatin and completed 4 cycles before transitioning to maintenance avelumab therapy. No disease progression was noted at 16 months post-treatment. Herein, we present a review of the literature and our management of the present patient.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.51157