bladder cancer has variable metastatic potential and almost any organ can be involved by metastasis . lymph nodes , liver , lung , and bone are the most common metastatic sites of urothelial carcinoma of the bladder , with skin , brain , heart , and kidney being rare sites of metastasis [ 1 - 3 ] . we report a case of urothelial carcinoma of the bladder with brain and abdominal skin metastasis . a 60-year - old man presented to the emergency room with severe dyspnea that had developed 20 hours earlier . after discharge , the patient had failed to attend routine follow - up visits for 8 years . after 8 years , he presented to the outpatient clinic with complaints of urethral bleeding . after a radiologic work - up , he received three cycles of systemic combination chemotherapy with gemcitabine and cisplatin for urothelial carcinoma metastasized to the lungs , both inguinal lymph nodes , and both iliac chain lymph nodes . however , the lymphadenopathy was so aggravated that the response to systemic chemotherapy seemed to be ineffective . brain ct revealed a 34 cm sized mass in the left cerebellar hemisphere ( fig . a metastasectomy was performed and the mass proved to be metastatic urothelial carcinoma ( fig . he underwent excisional biopsy of the skin lesions and the final histopathologic report was consistent with metastatic urothelial carcinoma ( fig . bladder cancer is commonly a disease of older age and is a common malignant disease of the urinary tract [ 1 - 4 ] . the korea national statistical office reported that an estimated 3,230 new cases of bladder cancer occurred in 2008 in korea with 1,007 deaths . bladder cancer has variable metastatic potential and almost any organ can be involved by metastasis . babaian et al .   reported that evidence of metastatic disease was found in a postmortem examination in approximately two thirds of patients with bladder cancer . the incidence of clinically detected distant metastases from urothelial carcinoma of the bladder reportedly ranges from 9.5% to 29% . lymph nodes , liver , lung , bone , and peritoneum are the most common metastatic sites of urothelial carcinoma of bladder , whereas skin , brain , heart , and kidney are rarely involved [ 1 - 3 ] . the first step in the metastasis of urothelial carcinoma of the bladder is local lymphatic spread into the obturator , superior gluteal , inferior gluteal , external iliac , and common iliac nodes . then , tumor cells disseminate through the para - aortic lymphatic chain to the thoracic duct and enter the general circulation . when the local nodes become obstructed , lymphohematogenous spread occurs by tumor cells shunted into the vascular compartment . hematogenous metastases spread either via the pelvic plexus into the inferior vena cava and general circulation or via the perivertebral vein into the azygos , hemiazygos , intercostals , and other systemic veins . skin and brain metastases from urothelial carcinoma of the bladder are relatively rare . according to the brain tumor registry of japan , urothelial carcinoma metastasizes to the brain hematogenously , and cancer cells are filtered by the lungs . therefore , brain metastasis may be secondary to pulmonary metastasis . mueller et al .   found that among 10,417 cases of cutaneous metastases , only 1.1% represented a primary urologic lesion . like brain metastasis , spector et al .   suggested that skin metastasis in urothelial carcinoma of the bladder is a result of increased longevity in successfully treated patients there are four mechanisms of metastatic dissemination by which the skin may be involved : 1 ) direct invasion from an underlying neoplasm , 2 ) iatrogenic implantation from an operation , 3 ) lymphatic spread , or 4 ) hematogenous spread . in this case , similar to a patient reported by ku et al . , skin metastasis was likely by hematogenous spread rather than other mechanisms . however , brain and skin metastasis is regarded as a late manifestation of systemic spread . the mean survival period of most patients with bladder cancer is relatively too short for manifestations of brain or skin metastatic lesions to develop . thus , our case suggests that brain or skin may be rare sites for metastatic lesions . major advances have occurred in the diagnosis of bladder cancer and metastatic disease since the early 1990s . new , effective , aggressive , multi - therapeutic approaches to bladder cancer involving radical operation and systemic combination chemotherapy are prolonging the survival period . these developments are likely to make encountering patients who have uncommon metastatic lesions from urothelial carcinoma of the bladder , such as brain or skin metastasis , a more frequent occurrence . therefore , clinicians should recognize the importance of a thorough physical examination including neurologic function and a general exam in patients with urothelial carcinoma .
brain and skin metastasis from urothelial carcinoma of the bladder is rare . 
 there have been few case reports of the clinical course of patients with metastatic urothelial carcinoma of the brain and skin . in the present case 
 , a 60-year - old man had undergone radical cystectomy with an ileal conduit owing to urothelial carcinoma ( t1n0m0 ) . 
 the patient developed dizziness 9 years later and a solitary brain tumor was discovered in his left cerebellar hemisphere . 
 the tumor was totally resected and the mass was verified to be metastatic urothelial carcinoma . 
 one year after the metastasectomy of the brain lesion , multiple erythematous nodular lesions developed on his abdominal skin . 
 the skin lesions were excised and verified to be metastatic urothelial carcinoma . 
 this report describes this case of urothelial carcinoma of the bladder that metastasized to the brain and abdominal skin .