Bladder metastasis without hematuria, following radiation therapy for lung adenocarcinoma

Bladder metastasis from lung adenocarcinoma is extremely rare. Unlike primary bladder urothelial tumors, the initial symptoms of this disease vary, and include pelvic pain, dysuria, and hematuria. There are few reports on cases without microscopic hematuria. An 86-year-old woman with a previous history of radiation therapy for lung adenocarcinoma complained of urinary frequency. A urinalysis was negative for hematuria and pyuria; thus, overactive bladder was suspected. However, the patient's symptom worsened considerably, and cystoscopy revealed bladder tumor. Transurethral resection of the bladder tumor was performed. Based on the histological, immunohistochemical examination and clinical history, the final pathological diagnosis was bladder metastasis from lung adenocarcinoma. The patient died 19 days after the operation due to severe disease progression. In this rare case, a patient with bladder metastasis from lung adenocarcinoma did not show microscopic hematuria. Cystoscopy and computed tomography helped to make a rapid and accurate diagnosis.