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Difference between revisions of "Adenocarcinoma of the urinary bladder"
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Adenocarcinoma of the urinary bladder (view source)
Revision as of 18:14, 2 November 2016
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Adenocarcinoma of the urinary bladder -- intermed mag.jpg | |||
| Width = | |||
| Caption = Adenocarcinoma of the urinary bladder. [[H&E stain]]. | |||
| Synonyms = primary adenocarcinoma of the urinary bladder | |||
| Micro = nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - '''essential''' | |||
| Subtypes = | |||
| LMDDx = [[urachal carcinoma]], invasive [[urothelial carcinoma]] with glandular differentiation, [[metastatic]] adenocarcinoma, direct extension of [[adenocarcinoma]] from an adjacent structure (esp. [[colorectal adenocarcinoma]]) | |||
| Stains = | |||
| IHC = CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin -ve (nuclei -ve, membranes +ve) | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = [[radical cystectomy grossing]], [[cystoprostatectomy grossing]] | |||
| Site = [[urinary bladder]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = +/-hematuria | |||
| Symptoms = | |||
| Prevalence = rare | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = | |||
| Tx = cystectomy | |||
}} | |||
'''Adenocarcinoma of the urinary bladder''', also '''primary adenocarcinoma of the urinary bladder''' and '''bladder adenocarcinoma''', is a very uncommon [[cancer|malignant]] [[urinary bladder|urinary bladder]] tumour. | '''Adenocarcinoma of the urinary bladder''', also '''primary adenocarcinoma of the urinary bladder''' and '''bladder adenocarcinoma''', is a very uncommon [[cancer|malignant]] [[urinary bladder|urinary bladder]] tumour. | ||
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**Frequently looks just like [[colorectal adenocarcinoma]]. | **Frequently looks just like [[colorectal adenocarcinoma]]. | ||
*Without urothelial differentiation - '''essential'''.<ref name=pmid23451748>{{Cite journal | last1 = Zhong | first1 = M. | last2 = Gersbach | first2 = E. | last3 = Rohan | first3 = SM. | last4 = Yang | first4 = XJ. | title = Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance. | journal = Arch Pathol Lab Med | volume = 137 | issue = 3 | pages = 371-81 | month = Mar | year = 2013 | doi = 10.5858/arpa.2012-0076-RA | PMID = 23451748 }}</ref> | *Without urothelial differentiation - '''essential'''.<ref name=pmid23451748>{{Cite journal | last1 = Zhong | first1 = M. | last2 = Gersbach | first2 = E. | last3 = Rohan | first3 = SM. | last4 = Yang | first4 = XJ. | title = Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance. | journal = Arch Pathol Lab Med | volume = 137 | issue = 3 | pages = 371-81 | month = Mar | year = 2013 | doi = 10.5858/arpa.2012-0076-RA | PMID = 23451748 }}</ref> | ||
*+/-Evidence of invasion such as: | |||
**[[Desmoplastic stroma]]. | |||
**Extensive disordered or cribriform growth. | |||
Subtypes:<ref name=pmid23772302>{{Cite journal | last1 = Abbas | first1 = M. | last2 = Kramer | first2 = MW. | last3 = Wolters | first3 = M. | last4 = Herrman | first4 = TR. | last5 = Becker | first5 = JU. | last6 = Kreipe | first6 = HH. | title = Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case. | journal = Rare Tumors | volume = 5 | issue = 1 | pages = e3 | month = Feb | year = 2013 | doi = 10.4081/rt.2013.e3 | PMID = 23772302 }}</ref> | Subtypes:<ref name=pmid23772302>{{Cite journal | last1 = Abbas | first1 = M. | last2 = Kramer | first2 = MW. | last3 = Wolters | first3 = M. | last4 = Herrman | first4 = TR. | last5 = Becker | first5 = JU. | last6 = Kreipe | first6 = HH. | title = Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case. | journal = Rare Tumors | volume = 5 | issue = 1 | pages = e3 | month = Feb | year = 2013 | doi = 10.4081/rt.2013.e3 | PMID = 23772302 }}</ref> | ||
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*Signet ring cell carcinoma. | *Signet ring cell carcinoma. | ||
*Clear cell carcinoma (also ''[[mesonephroid carcinoma]]''). | *Clear cell carcinoma (also ''[[mesonephroid carcinoma]]''). | ||
Note: | |||
*The presence of [[adenocarcinoma in situ]] suggests the lesion arose in the bladder.{{fact}} | |||
DDx: | DDx: | ||
*[[Urachal | *[[Urachal adenocarcinoma]] - dome of bladder. | ||
*Invasive [[urothelial carcinoma]] with glandular differentiation - has urothelial differentiation. | *Invasive [[urothelial carcinoma]] with glandular differentiation - has urothelial differentiation. | ||
*[[Metastatic]] adenocarcinoma | *[[Metastatic]] adenocarcinoma ''or'' extension of [[adenocarcinoma]] from a nearby structure | ||
**[[Colorectal adenocarcinoma]]. | **[[Colorectal adenocarcinoma]]. | ||
**[[Prostatic adenocarcinoma]] - esp. [[ductal adenocarcinoma of the prostate]]. | |||
**[[Endometrioid endometrial adenocarcinoma]]. | |||
*[[Tubular adenoma of the urinary tract]].<ref name=pmid23664485>{{Cite journal | last1 = Kao | first1 = CS. | last2 = Epstein | first2 = JI. | title = Tubular adenoma of the urinary tract: a newly described entity. | journal = Hum Pathol | volume = 44 | issue = 9 | pages = 1890-4 | month = Sep | year = 2013 | doi = 10.1016/j.humpath.2013.02.017 | PMID = 23664485 }}</ref> | |||
===Images=== | |||
====Case 1==== | |||
<gallery> | |||
Image: Adenocarcinoma of the urinary bladder -- low mag.jpg | Invasive AUB - low mag. (WC) | |||
Image: Adenocarcinoma of the urinary bladder -- intermed mag.jpg | Invasive AUB - intermed. mag. (WC) | |||
Image: Adenocarcinoma of the urinary bladder -- high mag.jpg | Invasive AUB - high mag. (WC) | |||
</gallery> | |||
====Case 2 - AIS==== | |||
<gallery> | |||
Image: Adenocarcinoma in situ of bladder -- very low mag.jpg | Adenocarcinoma in situ (AIS) - very low mag. | |||
Image: Adenocarcinoma in situ of bladder -- low mag.jpg | AIS - low mag. | |||
Image: Adenocarcinoma in situ of bladder -- intermed mag.jpg | AIS - intermed. mag. | |||
Image: Adenocarcinoma in situ of bladder -- high mag.jpg | AIS - high mag. | |||
</gallery> | |||
==IHC== | ==IHC== | ||
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*CK20 +ve. | *CK20 +ve. | ||
*CDX2 +ve (strong, diffuse). | *CDX2 +ve (strong, diffuse). | ||
*Beta-catenin | *Beta-catenin -ve (negative nuclear staining, positive membranous staining). | ||
**[[Colorectal adenocarcinoma]] typically has nuclear staining ''and'' membranous staining. | **[[Colorectal adenocarcinoma]] typically has nuclear staining ''and'' membranous staining. | ||
*Thrombomodulin +ve/-ve (~60% of cases). | *Thrombomodulin +ve/-ve (~60% of cases). | ||
**[[Colorectal adenocarcinoma]] -ve. | **[[Colorectal adenocarcinoma]] -ve. | ||
**[[Urothelial carcinoma]] +ve (~90% of cases). | **[[Urothelial carcinoma]] +ve (~90% of cases). | ||
===Images=== | |||
====Case 1==== | |||
<gallery> | |||
Image: Adenocarcinoma of the urinary bladder - beta-catenin -- low mag.jpg | AUB - beta-catenin - low mag. (WC) | |||
Image: Adenocarcinoma of the urinary bladder - beta-catenin -- intermed mag.jpg | AUB - beta-catenin - intermed. mag. (WC) | |||
Image: Adenocarcinoma of the urinary bladder - beta-catenin -- high mag.jpg | AUB - beta-catenin - high mag. (WC) | |||
Image: Adenocarcinoma of the urinary bladder - beta-catenin -- very high mag.jpg | AUB - beta-catenin - very high mag. (WC) | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
Urinary Bladder Tumour, Transurethral Resection: | |||
- Invasive adenocarcinoma into the lamina propria, see comment. | |||
- Muscularis propria not sampled. | |||
- Negative for lymphovascular invasion. | |||
Comment: | |||
No urothelial carcinoma component is identified. | |||
The differential diagnosis includes (1) primary adenocarcinoma of the | |||
bladder, (2) adenocarcinoma from another organ (direct extension or | |||
metastasis), (3) urothelial carcinoma with glandular differentiation | |||
without sampled urothelial carcinoma, and (4) urachal adenocarcinoma. | |||
Immunostaining of the tumour is as follows: | |||
POSITIVE: CK7, CK20, CK34betaE12. | |||
NEGATIVE: beta-catenin (membranous pattern only, nuclei are negative). | |||
The immunoprofile (beta-catenin = nuclei negative, CK7 = positive) and | |||
presence of an in situ component favours a primary adenocarcinoma of | |||
the bladder; however, this is uncommon. Nonprimary adenocarcinoma | |||
(e.g. colorectal adenocarcinoma) should be excluded clinically. | |||
</pre> | |||
==See also== | ==See also== | ||