Extravesical Pagetoid Spread of Urothelial Carcinoma in Situ A Report of Five Cases

BACKGROUND: Urothelial carcinoma in situ (CIS) of the bladder is classified as a flat lesion of the urothelium; it has a tendency to be multifocal and carries a high risk of recurrence and persistence. Approximately one-third of patients with urothelial CIS of the bladder develop invasive carcinoma if left untreated. There are a few reported cases of extravesical intramucosal extension (pagetoid spread) of urothelial CIS without prior documentation of primary muscle-invasive carcinoma. CASES: We present 5 cases of urothelial CIS that exhibited pagetoid spread to prostatic ducts, seminal vesicles, and the vagina. CONCLUSION: Pagetoid spread of urothelial CIS of the bladder may introduce uncertainty with regard to assignment of proper disease staging, and therefore uncertainty about appropriate cancer management.