Urothelial carcinoma metastases impacting the CNS: A 20-year retrospective series

Our group has a longstanding interest in metastases impacting the central nervous system (CNS), including spread from prostatic adenocarcinomas, thyroid carcinomas, and breast carcinomas, most of which metastasize to CNS sites at a later time after the primary tumor is well-known. However, one of the least frequent types of systemic malignancies to metastasize to brain or spine is urothelial carcinoma. Thus, few large studies from a single institution exist. Fewer still detail the interval between first diagnosis of primary tumor and CNS lesion, or whether a patient might have their first presentation of cancer in the brain or spine, thus prompting review of our 20-year experience.

Case identification via text word search of pathology databases from our adult and referral hospitals, 2002 to present. Demographic and clinical data were extracted from reports and the medical record.

15 cases, 11 male: 4 female, age range 37-82 years were identified. Nine had metastases to brain parenchyma, 5 to vertebral column impacting spinal cord, and 2 to skull, one of which had tumor extension into right parietal lobe. Strikingly, 5 of 15 patients had had their CNS-impacting metastasis as their first presentation of neoplastic disease.

CNS metastasis of urothelial carcinoma is a rare occurrence; nevertheless, pathologists should include urothelial carcinoma in their differential diagnosis as a type of cancer that can first present with a CNS-impacting metastasis.