Incidentally-Discovered Squamous Cell Carcinoma after Endoscopic Sphincterotomy

Area of Science:

• Urology
• Oncology
• Neuroscience

Background:

• Chronic bladder irritation is a known risk factor for bladder cancer, especially squamous cell carcinoma (SCC).
• Patients with spinal cord injury (SCI) often experience chronic bladder issues, leading to a substantially increased risk of bladder cancer (16-28 fold).
• SCC is disproportionately represented in bladder cancer cases among SCI patients, occurring 10 times more frequently than in the general population.

Observation:

• This report details a case of incidentally discovered SCC of the bladder.
• The SCC was found within sphincter/prostate chips during a procedure for a patient with neurogenic bladder secondary to SCI.
• The patient underwent sphincterotomy, and initial cystoscopic findings were negative for malignancy.

Findings:

• The study presents a unique case of bladder cancer diagnosis through surgical pathology specimens rather than traditional imaging or cystoscopy.
• This incidental finding underscores the importance of histopathological examination in diagnosing malignancy, even with negative initial assessments.
• The case reinforces the link between neurogenic bladder, chronic irritation from clean intermittent catheterization, and the development of SCC in SCI patients.

Implications:

• This case emphasizes the heightened risk of bladder cancer, specifically SCC, in individuals with SCI and neurogenic bladders.
• It suggests that even with negative cystoscopic findings, vigilance for bladder cancer is crucial in this high-risk population.
• The findings highlight the potential role of histopathological analysis of surgical specimens in detecting bladder cancer incidentally.