Figure 1. A )Pre operative contrast-enhanced CT Scan abdomen showing urinary bladder tumour. B) Ileal conduit stoma site showing metastasis. C) Post operative abdominal CT scan showing conduit site metastasis. D) Microscopic photograph of conduit site showing squamous cell carcinoma.
Cytology from the conduit urine did not show any malignant cells. The perineal wound infection was managed and the patient was scheduled for chemoradiotherapy for metastasis at the stoma site.
Ileal conduit has been widely in use for urinary diversion after a radical cystectomy, and primary malignant tumours arising in these conduits are uncommon. Although several cases have been reported, most are either transitional cell carcinoma (TCC) or adenocarcinoma. A case of squamous cell carcinoma (SCC) arising in a right ureteroileal anastomosis extending to an ileal conduit, which developed 11 years after a radical cystectomy for TCC of the bladder, has been reported . Involvement of an ileal conduit with recurrent carcinoma following a radical cystectomy for TCC of the bladder is relatively rare. Rosvanis et al reviewed the reported cases of recurrent TCC in an Ileal conduit and found that most of the patients with upper urinary tract tumours recurred at the ureteroileal anastomosis. The authors suggested that surgical implantation or auto implantation from the upper tract might have influenced recurrence at the ureteroileal junction . Most recurrent tumours in the ileal conduit reported to date have been either TCC or adenocarcinoma . Filmer and Spencer reviewed primary malignancies in bladder augmentations and urinary conduits, most of which were adenocarcinoma, and suggested that the inflammatory response associated with bacteriuria at the anastomotic site between transitional and enteric epithelia render the area more susceptible to malignant transformation .
Our case had all the resection margins negative for malignancy including both ureters. All the lymph nodes were negative for tumour. The possible explanation in this patient can be by tumour implantation theory. As the same set of instruments was used in radical cystectomy and constructing the ileal conduit, there might have been some tumour cell implantation in stoma site. This in our knowledge is the first case of squamous cell carcinoma urinary bladder developing metastasis at conduit stoma site without involving the ureteroileal anastomosis.
1. Weldon TE, Soloway MS: Susceptibility of urothelium to neoplastic cellular implantation. Urology 1975; 5:824
2. Green LF, Yalowitz PA: The advisability of concomitant transurethral excision of vesical neoplasm and prostatic hyperplasia. J Urol 1972; 107:445
3. Mydlo JH, Weinstein R, Shah S, et al: Long-term consequences from bladder perforation and/or violation in the presence of transitional cell carcinoma: Results of a small series and review of the literature. J Urol 1999; 161:1128.
4. Yamada Y, Fujisawa M, Nakagawa H etal: Squamous Cell Carcinoma in an Ileal Conduit. Int J Urol 1998;5:613-614.
5. Rosvanis TK, Rohner TJ, Abt AB :Transitiona1 cell carcinoma in an ileal conduit. Cancer 1989;63:1233-1236.
6.Sakano S,Yoshihiro S, Jolto I, Icawano H, Naito I : Adenocarcinoma developing in an ileal conduit. J Urol 1995; 153:146-8.
7.Filmer RB, Spencer JR: Malignancies in bladder augmentations and intestinal conduits. J Urol 1990;143:671-678.
Date added to bjui.org: 24/06/2011