Adenocarcinoma of the urinary bladder: Difference between revisions

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| Micro      = nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - '''essential'''
| Micro      = nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - '''essential'''
| Subtypes  =
| Subtypes  =
| LMDDx      = [[urachal carcinoma]], invasive [[urothelial carcinoma]] with glandular differentiation, [[metastatic]] adenocarcinoma (esp. [[colorectal adenocarcinoma]])
| LMDDx      = [[urachal carcinoma]], invasive [[urothelial carcinoma]] with glandular differentiation, [[metastatic]] adenocarcinoma, direct extension of [[adenocarcinoma]] from an adjacent structure (esp. [[colorectal adenocarcinoma]])
| Stains    =
| Stains    =
| IHC        = CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin +ve (membranous, not nuclear)
| IHC        = CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin -ve (nuclei -ve, membranes +ve)
| EM        =
| EM        =
| Molecular  =
| Molecular  =
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| Syndromes  =
| Syndromes  =
| Clinicalhx =
| Clinicalhx =
| Signs      =
| Signs      = +/-hematuria
| Symptoms  =
| Symptoms  =
| Prevalence = rare
| Prevalence = rare
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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 carcinoma]] - dome of bladder.
*[[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 ''or'' extension of [[adenocarcinoma]] from a nearby structure
*[[Metastatic]] adenocarcinoma ''or'' extension of [[adenocarcinoma]] from a nearby structure
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**[[Prostatic adenocarcinoma]] - esp. [[ductal adenocarcinoma of the prostate]].
**[[Prostatic adenocarcinoma]] - esp. [[ductal adenocarcinoma of the prostate]].
**[[Endometrioid endometrial adenocarcinoma]].
**[[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===
===Images===
====Case 1====
====Case 1====
<gallery>
<gallery>
Image: Adenocarcinoma of the urinary bladder -- low mag.jpg | AUB - low mag. (WC)
Image: Adenocarcinoma of the urinary bladder -- low mag.jpg | Invasive AUB - low mag. (WC)
Image: Adenocarcinoma of the urinary bladder -- intermed mag.jpg | AUB - intermed. 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 | AUB - high 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>
</gallery>


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*CK20 +ve.
*CK20 +ve.
*CDX2 +ve (strong, diffuse).
*CDX2 +ve (strong, diffuse).
*Beta-catenin +ve (membranous, not nuclear).
*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).
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