Stesura Seveso Archivio Italiano di Urologia e Andrologia 2024; 96(3):12784 1 LETTER TO EDITOR KEY WORDS: Breast cancer; Bladder cancer; Metastasis; Linitis plastica; Haematuria. Submitted 4 July 2024; Accepted 6 July 2024 Dear Editor, We read with interest the recently published article by Farci et al., titled “An unusual ‘linitis plastica’ like breast cancer bladder metastasis” and we congratulate with the authors for the very interesting topic and case presented (1). The authors have correctly reported data from the literature regarding the rate of bladder metastases from breast cancer, which appear to be approximately 2.4% of all bladder metastases. However, a recent systematic review of the literature 2 including 45 articles highlighted how in reality this percentage may be underestimated and probably higher. As indi- cated, some studies have reported rates of metastatic bladder involvement in breast cancer patients as high as 7% (2, 3). Most clinical presentations occur with the appearance of hematuria, sometimes even several years after the initial diag- nosis of breast cancer. In the case presented by colleagues 1 this occurred approximately 5 years after the diagnosis of breast cancer, and also in other cases presented in the literature the presentation of the metastasis can occur even more than 30 years after the diagnosis (2, 4). This delay in presentation can often make a timely diagnosis of the metastasis itself difficult, as the appearance of hema- turia often occurs after the end of the usual oncological follow-up for breast cancer (5). A further difficulty in this sense, during the follow-up, is also a lack of mutual knowledge on the part of the urologist and breast surgeon of the respec- tive pathologies. This can lead to a more difficult histopathological and immunohistochemical diagnosis post-TURB (6), given by the failure to communicate the previous history of breast cancer to the pathologist himself. A further focus must be placed on the fact that breast cancer is a pathology which is not only unfortunately relatively fre- quent in females, but sometimes also in young women in an aggressive and locally advanced form (7, 8). This draws attention to the importance of a correct medical history of patients, especially young ones, to better under- stand the appearance of hematuria and better direct the differential diagnosis, even with the aid of biomarkers (8, 9). Fortunately, bladder metastases from breast cancer remain rare events, although not exceptional. It therefore becomes essential, in our opinion, to also take this possibility into consideration in order to carry out a correct and timely diag- nosis. REFERENCES 1. Farci R, Tolu S, Trombetta M, et al. An unusual "linitis plastica" like breast cancer bladder metastasis. Arch Ital Urol Androl. 2024; 96:12483. 2. Malinaric R, Balzarini F, Granelli G, et al. From women to women-hematuria during therapy for metastatic breast cancer, what to suspect and when to be alarmed; Bladder metastasis from breast cancer-our experience and a systematic literature review. Front Oncol. 2022; 12:976947. 3. Hagemeister FB Jr, Buzdar AU, Luna MA, Blumenschein GR. Causes of death in breast cancer: a clinicopathologic study. Cancer. 1980; 46:162- 7. 4. De Rose AF, Balzarini F, Mantica G, et al. Late urinary bladder metastasis from breast cancer. Arch Ital Urol Androl. 2019; 91:60-62. 5. Cornacchia C, Dessalvi S, Santori G, et al. Breast Edema after Conservative Surgery for Early-Stage Breast Cancer: A Retrospective Single- Center Assessment of Risk Factors. Lymphology. 2022; 55:167-177. 6. Mantica G, Simonato A, Du Plessis DE, et al. The pathologist's role in the detection of rare variants of bladder cancer and analysis of the impact on incidence and type detection. Minerva Urol Nefrol. 2018; 70:594-597. Comment to “An unusual ‘linitis plastica’ like breast cancer bladder metastasis” Raquel Diaz 1, 2, Rosario Leonardi 3, Federica Murelli 1, 2, Piero Fregatti 1, 2, Carlo Terrone 1, 2, Guglielmo Mantica 1, 2 1 Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; 2 IRCCS Ospedale Policlinico San Martino, Genova, Italy; 3 Casa di Cura Musumeci GECAS, Gravina di Catania, Italy. DOI: 10.4081/aiua.2024.12784 Archivio Italiano di Urologia e Andrologia 2024; 96(3):12784 R. Diaz, R. Leonardi, F. Murelli, et al. 2 7. Fregatti P, Gipponi M, Diaz R, et al. The Role of Sentinel Lymph Node Biopsy in Patients With B5c Breast Cancer Diagnosis. In Vivo. 2020; 34:355-359. 8. Malinaric R, Mantica G, Lo Monaco L, et al. The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers-What Should a Urologist Really Know? Int J Environ Res Public Health. 2022; 19:9648. 9. Lopez-Gonzalez L, Sanchez Cendra A, Sanchez Cendra C, et al. Exploring Biomarkers in Breast Cancer: Hallmarks of Diagnosis, Treatment, and Follow-Up in Clinical Practice. Medicina (Kaunas). 2024; 60:168. Correspondence Raquel Diaz, MD raqueldiaz.ge@gmail.com Piero Fregatti, MD piero.fregatti@unige.it Carlo Terrone, MD carlo.terrone@med.uniupo.it Federica Murelli, MD federica.murelli@unige.it Guglielmo Mantica, MD (Corresponding Author) guglielmo.mantica@gmail.com IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy Rosario Leonardi, MD urologialeonardi@gmail.com Casa di Cura Musumeci GECAS, Gravina di Catania, Italy Conflict of interest: The authors declare no potential conflict of interest.