Definitive Histologic Diagnosis of Bone Marrow Carcinomatosis Followed by Dose‐Adjusted Chemotherapy in Metastatic Urothelial Carcinoma: A Case Report

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Abstract
Introduction: Bone marrow carcinomatosis (BMC) is a rare manifestation of metastatic urothelial carcinoma (UC) that may mimic hematologic disease and cause severe cytopenia, diagnostic difficulty, and rapid clinical deterioration. Case Presentation: A 65‐year‐old man presented with back pain, thrombocytopenia, and leukoerythroblastosis. Bone marrow aspiration resulted in a dry tap, but biopsy revealed diffuse carcinoma‐cell infiltration consistent with UC, establishing BMC as the cause of marrow failure. Because of profound marrow dysfunction, reduced‐dose gemcitabine and cisplatin chemotherapy was initiated, leading to hematologic recovery and radiologic improvement. The patient subsequently received standard‐dose chemotherapy and avelumab maintenance and survived for 12.4 months after diagnosis. Conclusion: Histologic confirmation is essential to distinguish UC‐related BMC from primary hematologic disease and may support individualized systemic treatment in carefully selected patients.

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