A 60-year-old man with a history of repeated urinary tract infections attended the emergency department for presenting a mass in the lower abdomen, of about six months' duration, which bled spontaneously and caused intense pain.
Physical examination revealed a bladder exstrophy plaque in the hypogastrium and a complete epispadic penis, which had not been surgically corrected during childhood. There was an exophytic formation in the sinus of the plaque, 10 cm in diameter and hard in consistency, with a friable surface that bled at the slightest friction. No inguinal lymph nodes were palpable and the rest of the examination revealed no other findings.

Blood tests showed a creatinine level of 2.2 mg/dL, with all other parameters being normal.
After admission to hospital to complete the study, bilateral renal ultrasound was performed, showing grade III/IV dilatation of both pyelocaliceal systems. Intravenous urography showed functional annulment of the right kidney, with delayed elimination of the left kidney.
The suspicious mass was biopsied and the histopathological result was bladder adenocarcinoma.
The thoraco-abdomino-pelvic CT scan and bone scan showed no evidence of metastasis.
The patient underwent surgery, with radical cystoprostatectomy with lymphadenectomy plus Indiana shunt and closure of the abdominal wall defect with fascia lata. Histopathological analysis of the surgical specimen revealed the existence of an intestinal adenocarcinoma with some signet ring cells. The margins of the specimen were infiltrated, with extensive involvement of adjacent soft tissue and peritoneum, and two iliac adenopathies infiltrated by the tumour were isolated. The tumour stage corresponded to T4bN2M0.
The medical oncology department rejected adjuvant treatment, considering that it would not increase the patient's survival.
At the check-up 6 months after surgery, a painless left inguinal lymphadenopathy of increased consistency was palpated, together with induration of the edges of the surgical wound, a finding compatible with local recurrence of the tumour that was confirmed by biopsy of the suspicious area. Bone scanning at this time remained negative and CT scan showed a heterogeneous mass with poorly defined borders in the surgical site.
The patient died 2 months later from sepsis of urinary origin.