Introduction: Transitional Cell Carcinoma (TCC) is the most common type of bladder cancer, accounting for approximately 95% of all cases, and is the 4th most common cancer in men. Luckily, TCC generally has a good prognosis with the majority staying localized to the bladder. TCC colonic metastasis, while rare, has been documented – however, metastasis for this patient presented as a totally different disease.
Case Description/Methods: A 88-year-old male with a history of bladder cancer and colon polyps came to the clinic for follow-up evaluation of proctitis, significant flatulence, tenesmus, and incontinence, after referral to a colorectal surgeon. The surgeon reported that anoscopy could not be completed due to significant rectal inflammation due to what appeared to be a stricture and recommended further evaluation for inflammatory bowel disease. A colonoscopy was conducted without complication and a diagnosis of indeterminate colitis, diverticulosis, sigmoid colon polyp, and proctitis was made. The 3 mm polyp was removed and sent to pathology as well as multiple biopsies taken 5cm from the anal verge to approximately 20 cm from the anus where the mucosa appeared edematous and friable. Pathology reported back with different diagnoses at different distances from the anus. Found at 5 cm from the anus was minimal focal active colitis and negative for atypia or malignancy. Found at 10 cm from the anus was mildly hyperplastic colonic mucosa and rare, atypical cells consistent with TCC in the lamina propria. Found at 15 cm from the anus was mildly hyperplastic colonic mucosa and rare, detached cells consistent with TCC in the lamina propria. Found at 20 cm from the anus was mildly hyperplastic colonic mucosa that was negative for colitis, atypia, and malignancy. The biopsies and results were sent to the for second opinion and were in concurrence with the initial interpretations.
Discussion: Based on the presenting symptoms and imaging this raised high suspicion for inflammatory bowel disease. But this case serves as a reminder that cancer can present in extremely unpredictable ways. It is crucial to confirm findings even when all leads are seemingly definitive for a common diagnosis. TCC with secondary rectal and colonic involvement can mimic inflammatory bowel disease with edema, nodularity, and stricturing.
