77-year-old male patient (HC 53.296/3), ex-smoker of 60 cigarettes/day, with a history of:

- Myocardial infarction. - Infrarenal abdominal aneurysm surgery. - Right renal lithiasis. - Arterial hypertension.

He consulted for presenting monosymptomatic macroscopic haematuria in 1999. He was diagnosed with transitional carcinoma of the bladder showing very focal micropapillary areas (G3-pT1) and areas of carcinoma in situ.

Subsequently he presented tumour recurrence in 2000 and 2004 diagnosed as carcinoma in situ and was treated with intravesical chemotherapy (BCG).

In January 2005 she came to our hospital with a tumour in the abdominal wall, at the level of the right iliac fossa, for which reason an abdominal CAT scan (computerised axial tomography) was performed which showed a solid mass measuring 7 x 6 cm in the musculature of the right anterior abdominal wall. Laparotomy was performed with en bloc resection of the abdominal wall. An irregular fragment weighing 180 g and measuring 9 x 9 x 7 cm was received at the pathology department. Serial sections identified a firm, whitish nodular lesion measuring 6 x 6 x 5 cm and not in contact with the resection edge, although it was focally close to it. The anatomopathological study showed a poorly differentiated carcinoma of high histological grade that frequently showed a micropapillary pattern and frequent permeation of lymphatic vessels, suggesting a metastatic origin. Immunohistochemistry was performed showing positivity for keratin (AE1-AE3) and cytokeratin (CK) 7 and negativity for CK20, TTF-1, N-Cam, Chromogranin and Synaptophysin. The final diagnosis was metastasis in the abdominal wall due to micropapillary bladder carcinoma.

Subsequently, PET (positron emission tomography) was performed, and a hypermetabolic focal deposit was observed in the right hemipelvis, in the path of the iliac, compatible with lymph node metastasis, a finding that was confirmed in a subsequent abdominopelvic CAT scan. However, no recurrence was detected in the bladder and urine cytology was negative. Four cycles of chemotherapy were administered according to the Carboplatin-Gemcitabine protocol and a complete response was observed on review. The patient is alive and disease-free 12 months after the initial diagnosis.