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Adenocarcinoma of the urinary bladder (view source)

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'''Adenocarcinoma of the urinary bladder''', also '''primary adenocarcinoma of the urinary bladder''', is a very uncommon [[cancer|malignant]] [[urinary bladder|bladder]] tumour.
{{ 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.


==General==
==General==
*Very rare.<ref name=pmid11762445>{{Cite journal  | last1 = Ranadive | first1 = NU. | last2 = Trivedi | first2 = VD. | last3 = Gadgil | first3 = NM. | title = Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view. | journal = Arch Esp Urol | volume = 52 | issue = 8 | pages = 906-11 | month = Oct | year = 1999 | doi =  | PMID = 11762445 }}</ref>
*Very rare<ref name=pmid11762445>{{Cite journal  | last1 = Ranadive | first1 = NU. | last2 = Trivedi | first2 = VD. | last3 = Gadgil | first3 = NM. | title = Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view. | journal = Arch Esp Urol | volume = 52 | issue = 8 | pages = 906-11 | month = Oct | year = 1999 | doi =  | PMID = 11762445 }}</ref> - approximately 0.5-2.0% of [[urinary bladder|bladder]] cancers.<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>


Clinical:
Clinical:
*Like [[urothelial carcinoma]] - usu. hematuria.<ref name=pmid11762445/>
*Like [[urothelial carcinoma]] - usually hematuria.<ref name=pmid11762445/>


==Microscopic==
==Microscopic==
Features:
Features:
*Nuclear pleomorphism.
*Nuclear pleomorphism - may be mild.
*Glandular differentiation.
*Usually glandular differentiation (most common).
*No urothelial differentiation - '''important'''.<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>
**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>
*+/-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>
*Glandular.
*Papillary.
*Colloidal (mucinous).
*Signet ring cell 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.
*[[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==
Line 24: Line 88:
*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]] usu. has nuclear 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==
Michael
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