Chen GY, Tsai HL, Chen PJ, Chen YC, Wang JY, Lin CY, Yin HL. Plasmacytoid urothelial carcinoma of the urinary bladder with colorectal metastasis and mimicking colitis: A case report. World J Clin Cases 2025; 13(30): 110314 [DOI: 10.12998/wjcc.v13.i30.110314]
Corresponding Author of This Article
Hsiang-Lin Tsai, MD, PhD, Professor, Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 80708, Taiwan. chunpin870132@yahoo.com.tw
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Guan-Ying Chen, Hsiang-Lin Tsai, Po-Jung Chen, Yen-Cheng Chen, Jaw Yuan Wang, Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
Chung-Yu Lin, Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
Hsin Ling Yin, Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
Author contributions: Chen GY, Tsai HL, and Wang YJ contributed to manuscript writing and editing, and data collection; Chen PJ and Chen YC contributed to conceptualization; Lin CY and Yin HL contributed to data analysis; all authors have read and approved the final manuscript.
Informed consent statement: The authors certify that they have obtained all appropriate patient consent forms where the patient has given his consent for the images and other clinical information to be reported in the journal while understanding that his name and initials will not be published and all due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest with regard to the content of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsiang-Lin Tsai, MD, PhD, Professor, Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 80708, Taiwan. chunpin870132@yahoo.com.tw
Received: June 4, 2025 Revised: July 9, 2025 Accepted: August 20, 2025 Published online: October 26, 2025 Processing time: 129 Days and 19.6 Hours
Abstract
BACKGROUND
Plasmacytoid urothelial carcinoma (PUC) is a rare histologic variant of urothelial carcinoma. PUC is characterized by aggressiveness and poor prognosis. Since the first reported case of PUC in 1991, approximately 100 cases have been documented. In patients with PUC, colorectal metastasis is an uncommon presentation that is difficult to diagnose because it can mimic colitis on imaging examination, exhibiting colorectal wall thickening with a preserved vesicorectal fat plane. The pathogenesis of urologic malignancies that metastasize to the colon remains unclear.
CASE SUMMARY
A 65-year-old Taiwanese man presented to our emergency department with a 3-month history of progressive abdominal fullness. A month before presentation, he had visited our hospital for gross hematuria with hydronephrosis and was subsequently hospitalized in our urology ward for transurethral resection of a bladder tumor. Postoperative histopathologic examination confirmed PUC. Regarding the illness at presentation, abdominal computed tomography revealed diffuse distension of the small and large intestines and long segmental thickening of the rectosigmoid colonic wall. Conservative management—empirical antibiotics, bowel rest, nasogastric tube decompression, and intravenous fluid support—was initiated with a presumptive diagnosis of colitis. Because of the patient’s inadequate response to conservative management, a diverting ileostomy was performed, which relieved the abdominal distension. Subsequent colonoscopic and histopathologic examinations with immunohistochemical staining confirmed colorectal metastasis through an atypical metastatic route.
CONCLUSION
Our case highlights diagnostic challenges posed by atypical imaging findings and unusual etiologies of gastrointestinal wall thickening with peripheral infiltration.
Core Tip: This report describes a case of colorectal metastasis in a 65-year-old man with plasmacytoid urothelial carcinoma. The patient had hospitalization with the impression of colitis with ileus initially for the image disclosed diffused bowel distension and long segmental rectosigmoid colonic wall thickening, with clear vesicorectal fat plane. And the colorectal metastasis with an unusal hypothesized pathogenesis was detected and confirmed by endoscopy and pathologic examinations with immunohistochemical staining. This case underscores the uncommon image findings and atypical pathway of metastases of bladder cancer to gastrointestinal tract.
