Case 2023: Juan (expert opinion by F. Guerrero-Ramos)

Juan, 77 years old, is famous for his paella, which is considered the best in Malaga. After his retirement as a master chef, the number of customers dropped significantly in the restaurant. Even Juan does not like to eat there anymore, after he discovered the paella was made with the wrong rice. Who does that?

He underwent a transurethral resection of bladder tumour (TURBT) of a papillary tumour at the right bladder wall, which was detected during a cystoscopic examination for painless haematuria.

Assessment summary:

• Pathological review:
  • Resection visually complete
  • pT1 high grade
  • Tumour diameter: 4.5 cm
  • No LVI
  • Muscle in specimen
• Comorbidities:
  • Arterial hypertension
  • Diabetes type II
  • Overweight
• ECOG PS: 2

He underwent a second TURBT, which revealed no residual tumour. BCG induction was started and followed by maintenance BCG. 6 months after start of BCG therapy (BCG induction and first course of BCG maintenance completed), a pTa high-grade recurrence was detected.