SEVERE, DIFFUSE OSTEOSCLEROSIS - A NEW MANIFESTATION OF TRANSITIONAL-CELL CARCINOMA OF THE URINARY-BLADDER

A 56 year-old man with a 2-year history of transitional-cell carcinoma of the urinary bladder presented with back pain and diffuse radiologi cal osteosclerosis. Laboratory studies revealed borderline-low ionized serum calcium, and markedly elevated serum alkaline phosphatase (ALP) activity and serum osteocalcin. Serum acid phosphatase and prostatic- specific antigen (PSA) were normal. Serum 25-hydroxyvitamin D and 1,25 -dihydroxyvitamin D were just below the normal limit and parathyroid h ormone was moderately elevated. A transiliac bone biopsy specimen reve aled expanded bone trabeculae, abundance of osteoid-covered surfaces, and heavy metastatic spread. To the best of our knowledge, this is the first description of the association of osteosclerosis and metastatic transitional-cell carcinoma of the bladder.