Neurological symptoms as the first presentation of transitional cell carcinoma of renal pelvis.

We present a rare case with history of neurological symptoms due to multiple brain metastases and no urological symptoms. During patient evaluation for primary tumor, transitional cell carcinoma (TCC) of left renal pelvis was found. The patient underwent gamma knife stereotactic radio-surgery for the metastatic brain lesions. Radical nephroureterectomy was performed, and a 4-cycle course of paclitaxel and carboplatin chemotherapy was administered for the patient. The disease is stable and the patient is still alive after the 34 months follow-up duration. Key Words: Transitional cell carcinoma; Brain metastases; Bladder; Urinary tract References 1. Murphy DM, Zincke H, Furlow WL. Management of high grade transitional cell cancer of the upper urinary tract. J Urol. 1981; 135:25–9. 2. Whitmore WP, Batata MA, Ghomein MA, GrabstaldH. Radical cystectomy with or without prior irradiation in the treatment of bladder cancer. J Urol. 1977; 118:184–7. 3. Bloch JL, Nieh PT, Walzak MP. Brain metastases from transitional cell carcinoma. J Urol.1987; 137:97–9. 4. Kabalin JN, Freiha FS, Torti FM. Transitional cell carcinoma of renal pelvis with multiple cerebral metastases. Urology.1990; 36:531–3. 5. Ricci PE. Imaging of adult brain tumors. Neuroimaging Clin N Am. 1999; 9: 651–69. 6. Huang CF, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for brainstem metastases. J Neurosurg. 1999; 91:563–8. 7. Mori Y, Kondziolka D, Flickinger JC, Logan T, Lunsford LD. Stereotactic radiosurgery for brain metastases from renal cell carcinoma. Cancer. 1998; 83(2):344–53. 8. Sternberg CN, Yagoda A, Scher HI, Watson RC, Herr HW, Morse MJ, et al. MVAC for advanced transitional cell carcinoma of the urothelium. J Urol. 1988; 139:461–9. 9. Steinfeld AD, Zelefsky M. Brain metastases from carcinoma of bladder. Urology.1987; 29: 375–6. 10. Siefker-Radtke AO, Walsh GL, Pisters LL, Shen Y, Swanson DA, Logothetis CJ et al. Is there a role for surgery in the management of metastatic urothelial cancer? The M.D Anderson experience. J Urol. 2004; 171:145–8. 11. Lohr F, Pirzkall A, Hof H , Fleckenstein K, Debus J. Adjuvant treatment of brain metastases. Semin Surg Oncol. 2001; 20:50–6. 12. Mahmoud-Ahmed AS, Suh JH, Kupelian PA, Klein EA, Peereboom DM, Dreicer R, et al. Brain metastases from bladder carcinoma: presentation, treatment and survival. J Urol. 2002; 167:2419–22. 13. Sanghavi SN, Miranpuri SS, Chappell R, Buatti JM, Sneed PK, Suh JH et al. Radiosurgery for patients with brain metastases: a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method. Int J Radiat Oncol Biol Phys. 2001; 51:426. 14. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. J Radiat Oncol Biol Phys. 1999; 45:427-34. 15. Sternberg CN, Yagoda A, Scher HI, Watson RC, Geller N, Herr HW, et al. MVAC for advanced transitional cell carcinoma of the urothelium: efficacy and patterns of response and relapse. Cancer. 1989; 64:2448–58. 16. Bamias A, Deliveliotis Ch, Fountzilas G, Gika D, Anagnostopoulos A, Zorzou MP, et al. Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced carcinoma of the upper urinary tract: a study by the hellenic cooperative oncology group. J Clin Oncol. 2004; 22:2150–4.