Radiological Case

Non-papillary Bladder Metastasis From Pancreatic Adenocarcinoma

Michael Cellini, MS-III; Daniel A. Deighton, MD


Appl Radiol. 2014;43(11) 

In This Article


Pancreatic cancer is the fourth-leading cause of death in the USA among men and women.[1] It accounts for 6% of all cancer mortalities in the U.S. in males, and 7% in females.[1] In 2013, an estimated 45,220 new cases of pancreatic cancer will be diagnosed nationwide.[1] Of those new cases, 38,460 people are expected to die.[1] Overall, pancreatic cancer accounts for 7% of all cancer deaths.[1] Clinically, the initial presentation of pancreatic cancer depends on location of the tumor. Approximately 60–70% of pancreatic tumors are located at the head of the pancreas, 20–25% are found in the body/tail, and infrequently, the entire organ is involved.[2] Tumors found in the head of the pancreas usually present with jaundice, steatorrhea, and weight loss.[3] This case represents a pancreatic carcinoma located in the tail of the pancreas which was found incidentally with no other signs and symptoms traditionally associated with the disease.

Urological manifestations usually occur in the late stages of pancreatic carcinoma.[4] When the urinary tract is involved, the left side usually predominates.[4] The most common manifestations of the urinary tract are ureteral obstruction and renal displacement.[4] Hematuria in pancreatic metastasis is rare unless there is mucosal ulceration.[6] The only 2 previously reported cases in American literature of metastatic pancreatic adenocarcinoma with hematuria were Kiefer in 1927[6] and Chiang in 1992.[5] In addition, the lesions presented as papillary bladder lesions different in character from ours. The case we have presented is similar to the aforementioned cases, but the bladder metastasis presented as a large, irregular, pedunculated mass invasive to the bladder.