University of Arizona College of Medicine Phoenix, AZ
Majd B. Aboona, MD, Claire Faulkner, BA, Brian M.. Fung, MD, Joseph David, MD University of Arizona College of Medicine, Phoenix, AZ
Introduction: Invasion of urothelial carcinoma into the gastrointestinal tract is a rare phenomenon with less than 50 previously reported cases in the literature. Even rarer is its invasion into the anal canal. Herein, we describe a case of advanced urothelial carcinoma with direct invasion into the anorectum leading to fecal incontinence.
Case Description/Methods: A 74-year-old male with a history of multiple genitourinary malignancies presented to the gastroenterology clinic with three months of worsening fecal incontinence. His oncological history included a remote history of testicular seminoma status post orchiectomy, low-grade prostate cancer, urothelial carcinoma of the ureter status post nephroureterectomy, and recurrent urothelial carcinoma in the bladder status post radical cystoprostatectomy (with R2 resection) and immunotherapy. He reported initially struggling with constipation, but that his stools subsequently became looser and more frequent, with up to 7 bowel movements per day. Although a recent surveillance colonoscopy for a history of polyps was normal 1 year earlier, a flexible sigmoidoscopy was subsequently performed for his fecal incontinence, and revealed submucosal fullness of the distal rectum with overlying granular appearing mucosa. Biopsies confirmed poorly differentiated carcinoma of urothelial origin, thought to be the cause of the patient’s incontinence. Given the extent of the patient’s disease, the patient opted for hospice care and passed away shortly after.
Discussion: Urothelial carcinoma with invasion into the anorectum is very rare and is associated with a poor prognosis. Our patient’s fecal incontinence might have otherwise been ascribed to age and prior pelvic surgery, especially in light of a recently normal colonoscopy. This case teaches that fecal incontinence may be an ominous symptom and should prompt a thorough workup, especially in patients with a history of malignancy in nearby structures.
Majd Aboona indicated no relevant financial relationships.
Claire Faulkner indicated no relevant financial relationships.
Brian Fung indicated no relevant financial relationships.
Joseph David indicated no relevant financial relationships.
Majd B. Aboona, MD, Claire Faulkner, BA, Brian M.. Fung, MD, Joseph David, MD. P3085 - Urothelial Carcinoma With Anorectal Invasion Causing Fecal Incontinence, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.