The micropapillary variant of urothelial
carcinoma (MPUC) is an aggressive form of urothelial
carcinoma with high metastatic potential and a poor prognosis. Although various
therapies have been reported, there is still no established treatment strategy for MPUC due to its rarity. The incidence of urinary tract
malignancies is higher in patients undergoing
hemodialysis (HD) than in healthy individuals. Here, we report the case of an 82-year-old man on HD with
end-stage kidney disease who visited our hospital for macrohematuria. Cystoscopy followed by computed tomography and urine cytology revealed a sessile papillary
tumor around the left bladder wall. We performed transurethral resection of the
bladder tumor. Based on histopathological and imaging findings indicative of clinical-stage T3N0M0 MPUC, we performed
radical cystectomy. Histopathology revealed a pathological stage T4aN0M0 MPUC. Two months after the
cystectomy, the patient complained of
constipation and painful defecation due to local recurrence and rectal invasion. While
colostomy was performed to improve defecation 3 months after
cystectomy, he did not receive any
chemotherapy due to his progressively worsening general condition. Six months after
cystectomy, he died following rapid
metastases. Our findings, in this case, confirm that
bladder cancer in HD patients tends to be pathologically more advanced. Therefore, regular screening is recommended for its early detection in HD patients.