Urothelial bladder cancer with cardiac metastasis: Literature review and case report

INTRODUCTION AND IMPORTANCE: Urothelial bladder cancer can infrequently result in cardiac metastasis, and be usually diagnosed in severe clinical conditions. We report a urothelial bladder cancer with cardiac metastasis and perform a literature review of published cases of transitional cell carcinoma (TCC) of the bladder with cardiac metastasis from 1934 to 2023 published in Pubmed. CASE PRESENTATION: 42-year-old woman with urinnary bladder TCC, underwent radical cystectomy, developing cardiac metastasis after 25 months, cardiac surgery for partial removal of the lesion and using pembrolizumab with the highest reported survival to date. CLINICAL DISCUSSION: After analysis of 20 case reports in the world among our case, men are more affected, tobacco exposure was the most prevalent risk factor, baseline T3 staging was the most common, and right ventricular and myocardium metastases are more prevalent. The most common symptoms were respiratory failure, changes in cardiac auscultation, and loss of weight. Six patients had cardiac tamponade, and the mean of drained fluid was 1040 ml. Immunohistochemical markers, such as CK7 and Calretinin, were decisive in elucidating the diagnosis. The average time between diagnosis of TCC and cardiac metastasis was 48.69 months, and the survival time after diagnosis of cardiac metastasis was 60.69 days. CONCLUSION: Bladder TCC with cardiac metastasis is rare and with a low survival rate after the diagnosis. Patients with more advanced stages of TCC deserve diagnostic suspicion of cardiac metastasis if they progress with previously unreported respiratory and cardiac symptoms.