Sarcomatoid urothelial carcinoma with disseminated metastases: an aggressive and rare cancer

Description

A 48-year-old woman with medical history of chronic obstructive pulmonary disease (COPD), hypertension and chronic tobacco abuse. She presented to the emergency department with new-onset supraventricular tachycardia. She denied any urological symptoms. Physical examination revealed a cachectic woman but otherwise unremarkable. Her laboratory investigations showed hypercalcaemia at 1.58 (Ref: 1.1 to 1.3mmol/L) with low 25-Hydroxy low vitamin D 25-Hydroxy at 5.6 at 5.6 (Ref: 30 to 100 ng/mL), low parathyroid hormone level <6.3 (Ref: 14 to 72 pg/mL) and elevated Parathyroid-related protein 83 (Ref: 14 to 27 pg/mL).

She had a chest, abdomen and pelvis CT scan to rule out any underlining malignancy. The results revealed significant enhancement and nodular urinary bladder wall with intraluminal hyperdensities. In addition, there were innumerable small cavitating lung nodules scattered throughout the lung fields, hypodense lesion involving the right hepatic lobe, splenic nodule, disseminated lymphadenopathy, osseous diseases involving L4, L2, T8 and compression deformity with superior endplate...

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