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Fluid & Brush Quiz 21 This patient is a 63 year-old white male smoker. He had a partial sigmoid-colectomy for colon cancer 3 years before presentation. Two years ago he had a biopsy of the urinary bladder that showed a high grade carcinoma without invasion. He presents now with hematuria. A urinalysis confirms the presence of microscopic blood. The patient states that he is weak and unable to work but is able to get around the house without difficultly. He has no other symptoms. Cystoscopy reveals no definite lesion. Bladder washings are taken and representative photos are presented below. The most probable diagnosis is:
Answer: (C) Metastatic adenocarcinoma of the colon.
Diagnostic Features in this case: The cells seen are too big and ugly to be secondary to the Candida present. The cells seems to have a bubblyy cytoplasm which is very common in mucin producing adenocarcinoma but not for urothellial carcinoma. A biopsy was performed following later demonstrated a mucin producing adenocarcinoma (Panel E and F).
Discussion: Adenocarcinoma of the colon with secondary involvement of the urinary bladder, by direction invasion or metastasis, is not uncommon. The prior diagnosis of urinary bladder carcinoma is a red herring.
If you pay attention, there are also many fungal organism with yeast and hyphae formation in the cytologic preparation. It is not uncommon that candida be seen in an ulcer in a hollow organ such as bladder and the gastrointestinal tract. The important thing is that they can co-exist with a malignant ulcerated tumor and should not be taken as the main diagnosis with the malignancy undiagnosed. Malignant cells in these cases can be scant and an astute observation and high index of suspicion is necessary.