A unique case of sequential superficial bladder cancer with solitary pulmonary metastasis achieving long-term disease-free survival post-metastasectomy: A case report and literature review

Urothelial carcinoma of the bladder most commonly metastasizes to lymph nodes, liver, bone, and lung. Solitary pulmonary metastasis from superficial (non-muscle-invasive) bladder cancer (NMIBC) is exceptionally rare. Furthermore, the long-term sequelae and subsequent cancer risk in such patients remain poorly defined. We report a case of a 76-year-old male with a history of high-grade T1 NMIBC who was found to have a solitary pulmonary nodule 19 months after completing Bacillus Calmette-Guérin (BCG) intravesical therapy. The patient underwent a successful pulmonary metastasectomy, with histopathology confirming metastatic urothelial carcinoma. He remained disease-free for seven years. Surprisingly, he then presented with de novo muscle-invasive bladder cancer (MIBC) without evidence of distant recurrence. He was managed conservatively being of old age and poor performance. This case highlights two rare phenomena: (1) the potential for superficial bladder cancer to distant metastases, and (2) the development of a new, aggressive primary tumor in the bladder long time after the control of metastatic disease. It underscores the importance of long-term, multidisciplinary surveillance for bladder cancer survivors, the biological heterogeneity of urothelial carcinoma, and the curative potential of metastasectomy in selected patients.