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Case Report Open Access

Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature

  • Authors:
    • Syah Mirsya Warli
    • Muhammad Haritsyah Warli
    • Ryan Ramon
    • Dedy Hermansyah
    • Causa Trisna Mariedina
    • Ginanda Putra Siregar
    • Dhirajaya Dharma Kadar
    • Fauriski Febrian Prapiska
    • Mutiara Indah Sari
    • Dewi Indah Sari Siregar
    • Zaimah Zulkarnaini Tala
  • View Affiliations / Copyright

    Affiliations: Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara‑Adam Malik Hospital, Medan 20136, Indonesia, Department of Urology, Faculty of Medicine, Universitas Indonesia‑Adam Malik Hospital, Medan 20136, Indonesia, Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia, Department of Anatomical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia, Department of Biochemistry, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia, Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara‑Haji Adam Malik General Hospital, Medan 20136, Indonesia, Department of Nutrition, Faculty of Medicine, Universitas Sumatera Utara, Medan 20155, Indonesia
    Copyright: © Warli et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 1
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    Published online on: November 18, 2025
       https://doi.org/10.3892/wasj.2025.416
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Abstract

Cyclophosphamide is an alkylating agent used in the treatment of solid tumors, including breast cancer. Cyclophosphamide therapy is associated with genitourinary side‑effects, such as hemorrhagic cystitis and bladder cancer. The duration of drug exposure and the total dose used have an impact on the probability of developing cancer associated with therapy. The present study describes the case of a 54‑year‑old female patient who was diagnosed with left‑sided breast cancer in 2015 and underwent a left‑sided mastectomy, followed by chemoradiation with cyclophosphamide and docetaxel as the chemotherapeutic regimen. However, 7 years later, the patient developed hematuria and was diagnosed with a bladder tumor. On the whole, as demonstrated herein, the risk of cyclophosphamide‑related malignancy increases with the cumulative dose and duration of exposure. Long‑term follow‑up is, therefore, necessary.
View Figures

Figure 1

Ultrasonography of the bladder. (Far
left and left images) Ultrasonography findings of the bladder
revealing bladder tumor with malignant suspicion. (Right and far
right images) Ultrasonography findings of right and left kidney,
respectively, suggesting normal morphology of the kidneys.

Figure 2

Histopathological features of
low-grade papillary urothelial carcinoma in the base of the urinary
bladder, illustrating (A) papillary fronds with fibrovascular cores
lined by urothelial cells in a noninvasive growth pattern (H&E
staining; magnification, x40); (B) orderly arranged urothelial
cells with minimal architectural disarray and preserved polarity
(H&E staining; magnification, x100); (C) mild nuclear atypia,
uniform nuclear size, and low mitotic activity consistent with
low-grade features (H&E staining; magnification, x400).
H&E, hematoxylin and eosin.

Figure 3

Histopathological features of
low-grade papillary urothelial carcinoma from tumor mass of the
urinary bladder, illustrating (A) delicate papillary architecture
with fibrovascular cores lined by multiple layers of urothelial
cells, without evidence of stromal invasion (H&E staining;
magnification, x40); (B) mild nuclear pleomorphism, preserved
polarity and orderly cell arrangement (H&E staining;
magnification, x100); (C) tumor cells with uniform round-to-oval
nuclei, fine chromatin, inconspicuous nucleoli, and low mitotic
activity, consistent with low-grade morphology (H&E staining;
magnification, x400). H&E, hematoxylin and eosin.

Figure 4

Abdominal CT scan. (A) Coronal view of
the CT scan illustrating focal inferior bladder thickening
suggestive malignancy of the bladder. (B) Axial slices of the CT
scan illustrating focal inferior bladder thickening suggestive
malignancy of the bladder. CT, computed tomography.

Figure 5

Routine cystoscopy performed on (A)
February 2023, (B) May 2023 and (C) August 2023.

Figure 6

Schematic diagram illustrating the
mechanisms of cyclophosphamide metabolism.
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Copy and paste a formatted citation
Spandidos Publications style
Warli SM, Warli MH, Ramon R, Hermansyah D, Mariedina CT, Siregar GP, Kadar DD, Prapiska FF, Sari MI, Siregar DS, Siregar DS, et al: Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature. World Acad Sci J 8: 1, 2026.
APA
Warli, S.M., Warli, M.H., Ramon, R., Hermansyah, D., Mariedina, C.T., Siregar, G.P. ... Tala, Z.Z. (2026). Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature. World Academy of Sciences Journal, 8, 1. https://doi.org/10.3892/wasj.2025.416
MLA
Warli, S. M., Warli, M. H., Ramon, R., Hermansyah, D., Mariedina, C. T., Siregar, G. P., Kadar, D. D., Prapiska, F. F., Sari, M. I., Siregar, D. S., Tala, Z. Z."Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature". World Academy of Sciences Journal 8.1 (2026): 1.
Chicago
Warli, S. M., Warli, M. H., Ramon, R., Hermansyah, D., Mariedina, C. T., Siregar, G. P., Kadar, D. D., Prapiska, F. F., Sari, M. I., Siregar, D. S., Tala, Z. Z."Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature". World Academy of Sciences Journal 8, no. 1 (2026): 1. https://doi.org/10.3892/wasj.2025.416
Copy and paste a formatted citation
x
Spandidos Publications style
Warli SM, Warli MH, Ramon R, Hermansyah D, Mariedina CT, Siregar GP, Kadar DD, Prapiska FF, Sari MI, Siregar DS, Siregar DS, et al: Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature. World Acad Sci J 8: 1, 2026.
APA
Warli, S.M., Warli, M.H., Ramon, R., Hermansyah, D., Mariedina, C.T., Siregar, G.P. ... Tala, Z.Z. (2026). Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature. World Academy of Sciences Journal, 8, 1. https://doi.org/10.3892/wasj.2025.416
MLA
Warli, S. M., Warli, M. H., Ramon, R., Hermansyah, D., Mariedina, C. T., Siregar, G. P., Kadar, D. D., Prapiska, F. F., Sari, M. I., Siregar, D. S., Tala, Z. Z."Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature". World Academy of Sciences Journal 8.1 (2026): 1.
Chicago
Warli, S. M., Warli, M. H., Ramon, R., Hermansyah, D., Mariedina, C. T., Siregar, G. P., Kadar, D. D., Prapiska, F. F., Sari, M. I., Siregar, D. S., Tala, Z. Z."Iatrogenic urothelial malignancy subsequent to adjuvant chemotherapy in breast oncology: A case report and brief review of the literature". World Academy of Sciences Journal 8, no. 1 (2026): 1. https://doi.org/10.3892/wasj.2025.416
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