Isolated cardiac metastasis from plasmacytoid urothelial carcinoma of the bladder

Bladder cancer is the fourth most common cancer in men in the United States. Most patients (69%) with metastatic bladder cancer have multiple organs involved; conversely, our patient had a PET scan indicating his disease was localized to the heart. Plasmacytoid urothelial carcinoma is a rare subtype of bladder cancer, and is estimated to make up less than three percent of all invasive bladder carcinomas. At the time of this publication we are aware of only three other reported instances of isolated cardiac metastasis with urothelial bladder origin; none of which were the plasmacytoid variant.This case highlights a previously unreported presentation of plasmacytoid urothelial carcinoma. Clinicians must remember that even superficial cancers can have significant metastatic potential.Urothelial cell carcinoma (UCC) with metastasis exclusively to the heart is an extremely rare and atypical presentation of a relatively common malignancy. A review of current literature yields only three other instances of this unusual metastatic pattern [1-3]. We present a 57-year-old male with plasmacytoid urothelial carcinoma (PUC) of the bladder and isolated metastasis to the heart. To our knowledge, an isolated cardiac metastasis from this rare type of UCC has never been reported in the literature.A 57-year-old male with a past medical history of hypertension, type-2 diabetes and superficial UCC presented with shortness of breath, substernal chest pain, and fevers. He was found to have a bladder mass four months earlier, for which he underwent cystoscopy and surgical removal. Pathology demonstrated high-grade superficial PUC extending into the submucosa but not the muscularis propria. Given the superficial nature of his bladder cancer, a cystectomy was deferred. He was subsequently lost to follow-up care.Upon presentation to our emergency department, the patient was tachycardic and tachypneic with distant heart sounds. An electrocardiogram (ECG) showed an incomplete right bundle branc