A case of bladder urothelial carcinoma that developed solitary metastasis to the left supraclavicular fossa lymph node after complete response to systemic chemotherapy

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  • Kamitomai Manami
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Oka Aiko
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Kanai Kengo
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Watanabe Yoshihiro
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Kitamura Hiroshi
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Okano Mitsuhiro
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Noguchi Yoshihiro
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Matsuoka Ryosuke
    Department of Pathology, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Kawai Koji
    Department of Renal and Urological Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital
  • Imanishi Yorihisa
    Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, International University of Health and Welfare, Narita Hospital

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Other Title
  • 化学療法完全奏効後に左鎖骨上窩リンパ節転移を認めた膀胱尿路上皮癌の1例

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Abstract

Although metastasis to the cervical lymph nodes from distant primaries is uncommon, genitourinary tract neoplasms, especially renal and prostate cancers, account for a significant proportion of such cases. However, metastasis of bladder cancer to the cervical lymph nodes is extremely rare. Herein, we report a patient with stage Ⅳ （T2N2M1） bladder urothelial carcinoma who once had shown complete response to a total of 14 cycles of systemic chemotherapy （Gemcitabine-CDDP） but a follow-up PET-CT five years later suggested that recurrent metastasis had developed to the left supraclavicular fossa lymph node. Since the distant metastasis was solitary and considered amenable to R0 resection, we performed selective level Ⅳ＋VB neck dissection instead of repeated systemic chemotherapy. Histopathological findings including immunohistochemical staining of CK7, CK20, and GATA3 confirmed lymph node metastasis from bladder urothelial carcinoma. The patient has remained recurrence-free to date without any additional postoperative treatment. Although salvage neck dissection could be applied in this case, its clinical benefit in terms of long-term survival is still unknown because of the lack of previous reports of similar cases, and so continuous close follow-up is required.

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