A Case of Recurrent Breast Cancer with Solitary Metastasis to the Urinary Bladder

Elderly patients with breast cancer often present with symptomatic, locoregionally advanced rather than screening-detected disease, thereby increasing the risk of metastatic recurrence during their remaining life time. Typical sites of metastases include lungs, bones, liver, and brain. Here we present a patient who developed a solitary urinary bladder metastasis five years after primary diagnosis of stage T4 N0 estrogen receptor-positive lobular carcinoma, while on continued adjuvant endocrine treatment (91 years of age). Anemia and increased serum creatinine resulting from hydronephrosis led to diagnosis of metastatic disease, which was confirmed by transurethral resection. The patient responded clinically to palliative radiotherapy and a different type of endocrine therapy. One year after diagnosis of metastatic disease, she died without signs of cancer progression. 1. Introduction Elderly patients with breast cancer often present with locally advanced and/or symptomatic disease because screening programs typically focus on younger women [1]. It has long been recognized that patients diagnosed with locally advanced disease also face a higher risk of metastatic recurrence during the course of disease [2]. Autopsy series from the last century showed that most distant metastases are located in the lymph nodes, lungs, pleura, bones, adrenal glands, liver, and brain [3]. However, other organs such as pituitary gland, kidneys, uterus, and thyroid gland might also be affected. Compared to these, the urinary bladder is a very rare site of distant relapse [4]. It is even more unusual that this type of metastatic spread is limited to only one organ. Here we report the clinical course of a patient with solitary metastasis to the urinary bladder. 2. Case Report In November 2007, an 86-year-old Caucasian female was diagnosed with left-sided clinical stage T4b N0 breast cancer, involving the whole breast and infiltrating the skin. She received primary endocrine treatment with letrozole. Her tumor responded well and in April 2008, mastectomy was performed. Histology showed lobular carcinoma grade I with 100% estrogen receptor (ER) positivity and negative progesterone receptor (PR) and Her-2 expression. Postoperatively, she continued on letrozole. In November 2012, she was hospitalized because of anemia (serum hemoglobin 6.9？g/dL) and reduced kidney function (serum creatinine 143？μmol/L). Ultrasound examination revealed bilateral hydronephrosis, and computed tomography (CT) of the chest, abdomen, and pelvis confirmed this finding (Figure 1). Furthermore, a diffuse