INTRODUCTION Bladder cancer is the most common cancer of the urinary tract with a peak incidence seen in 6th to 7th decade of life. The incidence is more common in males, nearly three-quarters of total bladder cancer occurs in men. Non muscle invasive bladder cancer (NMIBC) is the malignant urothelial tumor that is not involving the detrusor muscle. Approximately 70-80% of bladder tumors at presentation are NMIBC with 60-70% as Ta, 20-30% as T1 and 10% as CIS. Radical cystectomy is the gold standard treatment for muscle invasive bladder cancers, but should be considered in NMIBC with high risk for progression. CASE REPORT A 51 years old male patient, who is known case of bladder cancer (Low grade papillary urothelial carcinoma- pT1, N0) underwent radical cystectomy with orthotopic ileal neobladder 5 years ago on regular follow up, complained of right groin swelling for 2 weeks. On examination there was multiple right inguinal lymph nodes of largest of 2x2 cm size. In CECT abdomen and pelvis there was few necrotic inguinal lymphnodes without any significant abnormality in the neobladder or in rest of the abdominal organs . Urine cytology showed features suspicious of malignancy and the patient underwent cystoscopy which showed a small papillary growth at urethral anastamotic site. USG guided right inguinal lymphnode biopsy showed metastatic urothelial carcinoma and the wholebody PET-CT scan revealed increased FDG uptake in right iliac and right inguinal lymphnodes. DIAGNOSIS & TREATMENT The patient was diagnosed as Anastamotic site recurrence with metastasis and planned for chemotherapy. 4 cycles of cisplatin and gemcitabine was given following which the whole body PET-CT showed metabolic and morphologic regression of the right iliac and right inguinal lymph nodes. He subsequently underwent excision of the orthotopic ileal neobladder with urethrectomy and conversion to ileal conduit. The enlarged iliac lymphnodes were removed with right inguinal lymphnode dissection. CONCLUSION Recurrence and survival following radical cystectomy depends on the final pathological stage and lymphnode metastasis. The 5 year cancer specific survival following radical cystectomy is approximately 90 % for those with non-invasive disease on the final pathological examination. The risk of urethral recurrence following cystectomy range from 4-8% in men; risk factors are non-muscle invasive disease in the final pathology and prostatic urethral involvement. Inguinal lymphnode metastasis is uncommon in bladder cancer. Systemic therapy alone is not curative and metastasectomy should be considered in selected patients. Long-term follow up is essential for timely diagnosis and management of late recurrences following radical cystectomy.
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