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This article reports a rare case of primary signet-ring cell carcinoma of the bladder with transitional cell and adenocarcinoma variants and metachronous metastases to the penis and lungs. This combination of lesions has not previously been reported. Together, they portend widespread dissemination and an early demise as is frequently the case with signet-ring cell carcinomas arising in other organs such as the breast and gastrointestinal tract. The optimal therapeutic intervention for this myriad of neoplasms with metastasis to the penis has yet to be ascertained because of the rarity of the lesions. Early diagnosis and an aggressive surgical approach appear to offer the best chance for quality survival and possible cure.

In 4 patients with hypernephroma and extension of the tumor thrombus into the renal vein, there has been a significant degree of proteinuria. We believe that the proteinuria in association with a renal mass suggests a tumor thrombus in the renal vein and warrants the preoperative inferior venacavogram. After a larger number of patients have been studied, it may become clear that patients who do not have proteinuria do not have renal vein or vena caval involvement. If this proves to be the case, these patients may be selectively spared inferior venacavography. For the present time in patients with hypernephroma, we can only recommend that the index of suspicion for renal vein involvement with tumor thrombus should remain high if the patient has significant proteinuria.

A case is presented of renal cell carcinoma metastatic to the urinary bladder. The rarity of this lesion makes it worthy of report.

A case is reported in which the patient had classic findings of an abdominal aortic aneurysm, including a pulsatile abdominal mass, curvilinear aortic calcification, and anterolateral deviation of the left ureter. These findings were subsequently demonstrated at surgery to be due to metastatic nodes from prostatic carcinoma. Data presented indicate that further diagnostic studies may be in order in unusual cases in which patients are suspected of having abdominal aortic aneurysm. This is especially true if the patient is known to have another condition such as carcinoma which may mimic aneurysm with metastatic periaortic lymph nodes. Aortography and/or lymphangiography occasionally have their place in selected patients, and this is discussed.