Distant
metastasis is rare in patients with
non-muscle invasive bladder cancer (
NMIBC). We describe two cases of
NMIBC with distant
metastasis diagnosed in the follow-up period after transurethral resection (TUR), with neither intravesical recurrence nor progression to muscle-invasive disease. Case 1 : A 77-yearold man was referred to our hospital for treatment of a
bladder tumor with the complaint of asymptomatic gross
hematuria. TUR of the
bladder tumor was performed. Pathological examination revealed high grade urothelial
carcinoma pT1. Second TUR was performed and pathological examination confirmed high grade urothelial
carcinoma pT1 with lymphovascular invasion. The patient received standard BCG
therapy and subsequently developed left leg
pain and
lumbago 10 months after initial diagnosis. Magnetic resonance imaging, computed tomography, and bone scintigraphy demonstrated no local recurrence, but revealed multiple bone and liver
metastases. The patient died 15 months after initial diagnosis. Case 2 : A 70-year-old man was referred to our hospital for treatment of an incidental
bladder tumor. TUR of the
bladder tumor was performed and pathological examination confirmed high grade urothelial
carcinoma pT1. Second TUR was performed and pathological examination revealed no
residual tumor cells. 18Fflurodeoxyglucose (FDG) positron emission tomography/computed tomography confirmed increasing uptake of
18F-FDG in the retroperitoneal lymph nodes, 18 months after initial diagnosis. The patient underwent laparoscopic
lymphadenectomy. Pathological examination demonstrated
metastasis of the
bladder cancer. Combined
chemotherapy was initiated with
gemcitabine and
cisplatin consecutively. To date the patient survives without progression or new distant
metastases after four cycles of
chemotherapy.