Aggressive high-grade urothelial carcinoma transforming into enteric-type adenocarcinoma: a case report

Bladder cancer, a malignancy with high morbidity and mortality, predominantly affects older adults, with urothelial carcinoma as the most common histological type. However, enteric-type adenocarcinoma arising from high-grade urothelial carcinoma is an exceptionally rare and aggressive variant. This report details the case of a 44-year-old woman diagnosed at Rural Hospital. She presented with hematuria and frequent micturition, leading to a diagnosis of high-grade urothelial carcinoma with villoglandular differentiation. Despite multiple chemotherapy cycles (Gemcitabine-Carboplatin, followed by MVAC), the tumor progressed. Imaging revealed extensive invasion, necessitating radical anterior exenteration, including cystectomy, hysterectomy, and ileal conduit construction. Histopathology confirmed transformation into enteric-type adenocarcinoma with perineural and lymphovascular invasion but no lymph node metastases. Adjuvant radiotherapy was administered to mitigate recurrence risk. This case underscores the complexities of managing aggressive bladder carcinoma with histological transformation and highlights the need for a multimodal treatment strategy. Individualized approaches integrating surgery, chemotherapy, and radiotherapy are crucial. Further research is needed to establish standardized protocols and identify biomarkers for early detection and targeted therapy.