Early isolated bone metastases without local recurrence in non-muscle invasive bladder cancer

• The conventional clinicopathological factors are limited to predict the outcomes in bladder cancer.
• Combination of cellular regulatory markers has been demonstrated to improve the accuracy of prediction.
• This case is an unexpected case of NMIBC developed early and isolated bone metastases following surgery.
• The altered expressions of combined cellular biomarkers, p53, Ki-67, and EGFR, were observed diffusely and intensively in the all specimens.

IntroductionBladder 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.PresentationThe 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.DiscussionIt 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.ConclusionAs 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.