Taverna et al. BMC Cancer 2010, 10:62 http://www.biomedcentral.com/1471-2407/10/62 C A S E R E P O R T Open Access Bladder metastases of appendiceal mucinous adenocarcinoma: a case presentation Gianluigi Taverna1*, Matteo Corinti1, Piergiuseppe Colombo2, Fabio Grizzi3, Mauro Severo1, Alessando Piccinelli1, Guido Giusti1, Alessio Benetti1, Paolo A Zucali4, Pierpaolo Graziotti1 Abstract Background: Appendiceal adenocarcinoma is rare with a frequency of 0.08% of all surgically removed appendices. Few cases of appendiceal carcinoma infiltrating the bladder wall for spatial contiguity have been documented. Case Presentation: A case is reported of a 45-years old woman with mucinous cystadenocarcinoma of the appendix with bladder metastasis. Although ultrasonography and voided urinary cytology were negative, abdomen computed tomography (CT) scan and cystoscopy and subsequent pathological examination revealed a mass exclusively located in the anterior wall of the bladder. Histopathology of the transurethral bladder resection revealed a bladder adenocarcinoma [6 cm (at the maximum diameter) × 2,5 cm; approximate weight: 10 gr] with focal mucinous aspects penetrating the muscle and perivisceral fat. Laparotomy evidenced the presence of a solid mass of the appendix (2,5 cm × 3 cm × 2 cm) extending to the loco-regional lymph nodes. Appendectomy and right hemicolectomy, linfoadenectomy and partial cystectomy were performed. The subsequent pathological examination revealed a mucinous cystadenocarcinoma of the appendix with metastatic cells colonising the anterior bladder wall and several colic lymph nodes. Conclusions: The rarity of the appendiceal carcinoma invading the urinary bladder and its usual involvement of nearest organs and the posterior bladder wall, led us to describe this case which demonstrates the ability of the appendiceal cancer to metastasize different regions of urinary bladder. Background The appendiceal adenocarcinoma invading the urinary bladder is extremely rare [1-4], and it is very difficult to be diagnosed before the surgical inspection. Here we describes a case of appendiceal cystoadenocarcinoma metastising the bladder anterior wall diagnosed in a patient with monosymptomatic episodes of gross hema- turia. Our diagnostic schema and the adopted pharma- cological treatment are also discussed. Case Presentation A 45-years old woman presented at our health centre (IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy) with some episodes of gross hematuria. The ultra- sonography and voided urinary cytology, and the physi- cal examination were negative. The patient never had any gastrointestinal symptom and presented a negative * Correspondence: gianluigi.taverna@humanitas.it 1Department of Urology, Via Manzoni 56 - 20089 Rozzano, Milan, Italy regress medical history. The enhanced abdomen com- puted tomography (CT) scan evidenced a solid mass [6 cm (at the maximum diameter) × 2,5 cm] at the level of the anterior bladder wall (Figures 1 and 2). Cysto- scopy confirmed the presence of a 6 cm extended solid broad-based mass localized at the level of the anterior wall of the bladder. A transurethral resection was there- fore performed and the first pathological examination revealed a mucinous adenocarcinoma suspicious for pri- mary of the bladder (approximate weight: 10 gr), infil- trating the full thickness of the visceral wall (Figures 3A and 3B). Tumoural cells were found immunopositive for cytokeratin 7, CDX2 (nuclear immunoreactivity), and b- catenin (membranous immunoreactivity) (Figures 4A-C). Subsequent laparotomy showed a thickened appendix and caecum adherent to the bladder posterior wall with- out its infiltration. Intraoperative frozen analysis revealed foci of adenocarcinoma with mucinous compo- nents suspicious of colonic origin in sections of appen- diceal tissue, and the presence of tumoral cells © 2010 Taverna et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.