Table 1: Summary of cases.
Characteristic | Case 1 | Case 2 |
Histopathology of the primary tumor | Non-muscle invasive urothelial cancer | High grade muscle-invasive urothelial carcinoma |
Treatment of primary | Intravesical BCG with 3 monthly surveillance | Neoadjuvant chemotherapy with cisp latin and gemcitabine followed by radical cystectomy |
Any other metastasis before diagnosis of brain lesion | No | Lumbar spine and pelvic bones, liver |
Time to brain lesion | 8 years after original tumor | 1 year and 10 months |
Location of brain lesion | Right frontal lobe | Right frontal lobe |
Number of lesions | Solitary | Solitary |
Character of brain lesion on imaging | Initial heterogeneous enhancing intra-axial mass with mild surrounding edema; subsequent diffuse and focal areas of dural enhancement overlying right cerebral hemisphere | Bilobed enhancing lesion with restricted diffusion with mild surrounding vasogenic edema |
Symptoms at presentation | Left upper extremity paralysis | Left upper extremity paralysis |
Pathology of the brain lesion | Metastatic high grade papillary carcinoma consistent with metastatic urothelial carcinoma | Bacterial abscess; no neoplasm |
Treatment of the initial brain lesion | Right frontal craniotomy, gamma knife treatment and whole brain radiation | Resection and systemic antibiotics |
Clinical outcome | Progression of intracranial metastases within several months | Resolution of abscess, but progression of metastatic urothelial carcinoma |
Recurrence of brain metastasis after initial treatment | Yes | Not applicable |