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SMALL CELL CARCINOMA OF THE URINARY BLADDER; 3 CASES REPORTED FROM KING FAHAD SPECIALISTS HOSPITAL, KINGDOM OF SAUDI ARABIA

Abdulrahman M. Alamri, Abdulrahim M. Alamri, Mohammed Gomha

Abstract: Small cell carcinoma of the bladder is an extremely rare malignant growth. Its incidence accounts for what is less than 1% of all the primary urinary bladder carcinomata and it should be considered and treated as metastatic disease, even if there is no radiologic evidence of disease outside the bladder. The etiology of this disease is unclear but a theory proposes that small cell carcinoma of the bladder originates from multipotent stem cells and the coexistence of small cell carcinoma of the bladder with other types of bladder malignancies, such as transitional cell carcinoma supports this theory. Three cases all shared hematuria in their presentation. After further investigation, all were diagnosed with small cell carcinoma of the bladder, with and without other types of malignancies and were managed accordingly. The first underwent chemotherapy which consisted of cisplatin/etoposide and palliative radiotherapy. He was issued a DNR later. The second underwent Trans Urethral Removal of Bladder Tumor (TURBT), and chemo-radiation as definitive treatment that took 8 cycles of (cisplatine + etoposide + radiotherapy). Patient was well and cancer-free after 6 years of follow up. The third patient was treated with radical cystectomy, palliative radiation to brain metastases, Androgen Deprivation Therapy (ADT), as well as chemotherapy (goserline + nivolumab) from November, 2018 and until the current moment.Due to the low incidence of small cell bladder carcinoma, there are no clinical data based on prospective case control studies, therefore, more research is necessary to analyse the best plan for its treatment.

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