Adenocarcinoma of the urinary bladder

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Adenocarcinoma of the urinary bladder
Diagnosis in short

Adenocarcinoma of the urinary bladder. H&E stain.

Synonyms primary adenocarcinoma of the urinary bladder

LM nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - essential
LM DDx urachal carcinoma, invasive urothelial carcinoma with glandular differentiation, metastatic adenocarcinoma, direct extension of adenocarcinoma from an adjacent structure (esp. colorectal adenocarcinoma)
IHC CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin -ve (nuclei -ve, membranes +ve)
Grossing notes radical cystectomy grossing, cystoprostatectomy grossing
Site urinary bladder

Signs +/-hematuria
Prevalence rare
Treatment cystectomy

Adenocarcinoma of the urinary bladder, also primary adenocarcinoma of the urinary bladder and bladder adenocarcinoma, is a very uncommon malignant urinary bladder tumour.

General

Clinical:

Microscopic

Features:

  • Nuclear pleomorphism - may be mild.
  • Usually glandular differentiation (most common).
  • Without urothelial differentiation - essential.[3]
  • +/-Evidence of invasion such as:

Subtypes:[2]

  • Glandular.
  • Papillary.
  • Colloidal (mucinous).
  • Signet ring cell carcinoma.
  • Clear cell carcinoma (also mesonephroid carcinoma).

Note:

DDx:

Images

Case 1

Case 2 - AIS

IHC

Features - variable:[5]

Images

Case 1

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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.

See also

References

  1. 1.0 1.1 Ranadive, NU.; Trivedi, VD.; Gadgil, NM. (Oct 1999). "Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view.". Arch Esp Urol 52 (8): 906-11. PMID 11762445.
  2. 2.0 2.1 Abbas, M.; Kramer, MW.; Wolters, M.; Herrman, TR.; Becker, JU.; Kreipe, HH. (Feb 2013). "Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case.". Rare Tumors 5 (1): e3. doi:10.4081/rt.2013.e3. PMID 23772302.
  3. Zhong, M.; Gersbach, E.; Rohan, SM.; Yang, XJ. (Mar 2013). "Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance.". Arch Pathol Lab Med 137 (3): 371-81. doi:10.5858/arpa.2012-0076-RA. PMID 23451748.
  4. Kao, CS.; Epstein, JI. (Sep 2013). "Tubular adenoma of the urinary tract: a newly described entity.". Hum Pathol 44 (9): 1890-4. doi:10.1016/j.humpath.2013.02.017. PMID 23664485.
  5. Roy, S.; Parwani, AV. (Dec 2011). "Adenocarcinoma of the urinary bladder.". Arch Pathol Lab Med 135 (12): 1601-5. doi:10.5858/arpa.2009-0713-RS. PMID 22129192.