title: Urothelial Cancer With Occult Bone Marrow Metastases and Isolated Thrombocytopenia.
abstract: Bladder cancer rarely presents clinically with a myelophthisic picture from diffuse bone marrow infiltration especially in the absence of detectable skeletal metastases. A 75-year old man presented with newly diagnosed urothelial cell carcinoma of the bladder. Pathology from transurethral resection of bladder tumor demonstrated muscle-invasive disease. Pre-therapy imaging including CT abdomen/pelvis, CXR and bone scan demonstrated liver lesions concerning for metastatic disease but no skeletal metastases. Labs were notable for isolated thrombocytopenia, hypercalcemia and acute kidney injury prompting hospitalization. Hematologic work-up including bone marrow aspiration and biopsy revealed diffuse infiltration of the bone marrow by urothelial cancer. The case illustrates the importance of fully investigating otherwise unexplained clinical findings in patients with clinically localized urothelial cancer prior to curative intent surgery.
authors.affiliation: University of Michigan, Comprehensive Cancer Center, USA; Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, USA.
authors.forename: Ajjai
authors.initials: A
authors.lastname: Alva
authors.affiliation: University of Michigan, Comprehensive Cancer Center, USA; Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Davis
authors.affiliation: University of Michigan, Comprehensive Cancer Center, USA; Department of Pathology, University of Michigan, USA.
authors.forename: Arul M
authors.initials: AM
authors.lastname: Chinnaiyan
authors.affiliation: University of Michigan, Comprehensive Cancer Center, USA; Department of Pathology, University of Michigan, USA.
authors.forename: Saravana
authors.initials: S
authors.lastname: Dhanasekaran
authors.affiliation: University of Michigan, Comprehensive Cancer Center, USA; Department of Pathology, University of Michigan, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Mehra
keywords: Bone marrow metastases; Thrombocytopenia; Urothelial cancer