A 48-year-old man in Salé, Morocco, presented to an emergency department with persistent epigastric pain, hematemesis, and severe lower urinary tract symptoms, according to Cureus.
Global cancer statistics place stomach cancer fifth in both incidence and mortality worldwide, with over 980,000 cases reported globally in 2024, Cureus reported.
In Morocco, stomach cancer remains among the most frequent gastrointestinal malignancies, showing 788 new cases in the Casablanca region between 2017 and 2021.
Secondary bladder involvement accounts for roughly 2% to 3% of all malignant bladder tumors, typically occurring through pelvic extension or distant metastasis.
The patient arrived at a tertiary-care center 15 days before his diagnosis, suffering from untreatable epigastric pain, hematemesis, haematuria, and bilateral low back pain, Cureus reported.
An initial gastroscopy revealed a large ulcerated mass measuring over 136 mm on the lesser curvature of the stomach, narrowing the gastric lumen significantly.
Pathological examination of the gastric mass confirmed an infiltrating gastric adenocarcinoma characterized by independent signet-ring cells.
A subsequent computed tomography scan of the chest, abdomen, and pelvis showed a process affecting the right gastric wall alongside regional lymphadenopathy and peritoneal carcinomatosis, Cureus reported.
The imaging also uncovered circumferential thickening of the bladder wall reaching a maximum thickness of 20 mm.
Both ureters and the pelvicalyceal system showed bilateral dilation due to the obstruction.
Cystoscopy revealed an infiltrative, rigid, and multinodular bladder mucosa with intermittent bleeding, prompting a transurethral resection of the bladder, Cureus reported.
Histological examination of the bladder biopsies confirmed a poorly differentiated carcinomatous process that tested positive for CK7 and CK20 and negative for P63 and GATA3.
These immunohistochemical markers ruled out primary bladder cancer and verified the gastric metastatic origin.
Doctors placed a urinary catheter on the fourth day of admission, which quickly resolved the pelvicalyceal dilatation and improved renal function from a glomerular filtration rate of 21 mL/min up to normal levels, Cureus reported.
The patient was subsequently started on a chemotherapy regimen following the FOLFOX protocol.
A follow-up assessment two weeks after starting chemotherapy showed the patient had improved clinically, normal renal function, and less bladder wall thickening on radiological monitoring.
Secondary bladder locations account for only 2% to 3% of all malignant bladder tumors, making distant metastasis from a gastric primary an exceptionally rare clinical event.
The 48-year-old patient suffered from persistent epigastric pain, vomiting blood, visible blood in his urine, and bilateral lower back pain.
Medical staff placed a urinary catheter to relieve renal impairment and initiated a chemotherapy regimen following the FOLFOX protocol.
Pathological examination confirmed an infiltrating gastric adenocarcinoma with signet-ring cells that had spread to the bladder mucosa.