title: Early isolated bone metastases without local recurrence in non-muscle invasive bladder cancer.
abstract: BACKGROUND
  Bladder cancer exhibits a broad spectrum of heterogenous clinical behavior. Conventionally used clinicopathological factors are associated with certain limitations regarding the accurate prediction of outcome. Recent studies have focused on the predictive role of cellular regulatory markers.
  
  
  METHODS
  The present case aimed to describe an extremely rare case of non-muscle invasive bladder cancer (NMIBC) patient with early isolated bone metastases following curative surgery. An assessment of the alterations of cellular regulatory biomarkers using immunohistochemistry was performed and a review of previous literatures is presented.
  
  
  CONCLUSIONS
  It is very unusual feature that the patients with NMIBC who developed bone metastases without regional lymph node metastasis or local invasion. The patient had a solitary, high-grade T1 tumor which was not associated with carcinoma in situ and microscopic lymphovascular invasion. However, it had rapidly metastasized to distant sites following definitive surgery and exclusively limited to bones. Of special interest appears that altered expressions of combined cellular biomarkers including p53, Ki-67, and epidermal growth factor receptor were not observed focally, but rather diffusely and intensively throughout the tumor tissue.
  
  
  CONCLUSIONS
  As an accurate prediction of outcome in patient with bladder cancer is currently limited, individual targeted approach based on pathological biomarkers may be helpful to determining what treatments are best or when the optimal time is.
authors: Department of Urology, Dankook University College of Medicine, Cheonan, Republic of Korea. Electronic address: hjh178@medimail.co.kr.
authors: Jeong Hee
authors: JH
authors: Hong
keywords: Immunohistochemistry; Neoplasm metastasis; Urinary bladder neoplasms