THER-05. SOLITARY CEREBRAL METASTASIS FROM TRANSITIONAL CELL CARCINOMA OF THE BLADDER

INTRODUCTION: Brain metastasis is the most common neurological neoplasia seen in adults. They typically metastasize from primary lung or breast but very seldom is bladder cancer the culprit. Transitional cell carcinoma (TCC) of the bladder accounts for less than 1% of brain metastasis and few cases have been reported in literature. Here we present a rare case of TCC presenting with signs of neurological impairment. CASE DESCRIPTION: A 75-year-old male with history of TCC presented to the emergency department with right upper extremity hemiparesis and dysarthria of 5 hours duration. He had undergone cystoscopy with resection of tumor 3 years prior followed by gemcitabine chemotherapy and combination radiotherapy/immunotherapy. CT imaging revealed a hyperdense 3.3 cm mass in the left frontoparietal region with internal hemorrhage measuring 1.4 cm and surrounding vasogenic edema. He was immediately treated with high dose corticosteroids and antiepileptics which did not result in improvement of his symptoms. Metastatic workup which included contrast enhanced CT of chest, abdomen and pelvis revealed no evidence of local or metastatic recurrence. Due to rapid worsening of his status, respiratory failure and encephalopathy, family did not want to pursue additional treatment and decided on inpatient hospice. The patient died 3 weeks later due to rapid neurological decline. DISCUSSION: According to literature, CNS involvement of disseminated TCC varies from 0.6% - 8%, and bladder carcinoma accounts for 0.5% of all intracranial metastases. Incidence of CNS involvement without evidence of recurrence or disseminated disease is extremely uncommon. Aggressive multitherapeutic regimens, which include gemcitabine, have been favored for its penetration of the blood-brain barrier but even with its use disease may present years later with an unfavorable prognosis. Although metastasis from TCC of the bladder is rare any decline in neurological status should warrant further investigation in these patients.