Adenocarcinoma primario de vejiga en paciente femenina reporte de un caso y revisión de la literatura

Description: a 54-year-old woman presented to the emergency department complaining of severe pelvic pain accompanied by hematuria and a palpable, indurated hypogastric mass extending into the mesogastrium, associated with local inflammatory signs. She reported a previous external biopsy consistent with bladder adenocarcinoma; therefore, additional staging workup was performed to rule out secondary origins. Ultimately, the patient was diagnosed with primary bladder adenocarcinoma and underwent an anterior pelvic exenteration combined with bilateral ilioobturator lymphadenectomy, a Hartmann's colostomy, and a Bricker ileal conduit urinary diversion. The initial postoperative course at two months was favorable. However, due to systemic disease progression (lung metastases), a resolved perioperative episode of Takotsubo cardiomyopathy, and the patient's active refusal of the proposed palliative systemic chemotherapy (CAPOX regimen), she was referred to palliative care support, completing six months of follow-up Relevance: it is important to have evidence-based studies with similar cases that allow us to better address this pathology. Therefore, this case report aims to contribute to the current medical literature. Clinical implications: primary bladder adenocarcinoma represents between 0.5 % and 2.5 % of bladder tumors and is a pathology with limited evidence. A clinical case is presented to contribute evidence to the literature. Conclusions: when a bladder mass with atypical characteristics and aggressive behavior is present, primary bladder adenocarcinoma should be considered as a differential diagnosis, allowing for timely clinically and surgically targeted treatment.