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Bladder
Other Carcinomas
Adenocarcinoma
Author: Nat Pernick, M.D. (see Authors page)
Revised: 23 December 2009, last major update - December 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
See also in situ and urachal adenocarcinoma
Definition
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● Defined as malignant glandular tumor differentiated towards colonic mucosa
● Restrict diagnosis to pure adenocarcinomas
● Epicenter is mucosa, not muscularis propria (in urachal adenocarcinoma)
Terminology
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●
Epidemiology
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● 2/3 occur in men; mean age 68 years
● Patients are older (mean 62 years), and mucusuria is more common than in urachal adenocarcinomas
Sites
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● Usually lateral wall or trigone of bladder
Etiology
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● Some cases may be due to progression of extensive intestinal metaplasia (cystitis glandularis), arising at trigone, usually enteric
● Exstrophy (diffuse intestinalization; 7% develop adenocarcinoma, even after repair)
● Diverticula (usually develop urothelial carcinoma, occasionally adenocarcinoma)
● Also endometriosis, pelvic lipomatosis, Schistosoma haematobium
Clinical features
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● 1-2% of bladder carcinomas
● Usually present with hematuria
Prognostic factors
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● 5 year survival is 20-40%
● Stage is most important prognostic feature
● Compared to urothelial carcinoma, patients present at more advanced stage, but have similar prognosis (Urology 2009 Dec 16 [Epub ahead of print])
Case reports
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● 77 year old woman with colloid carcinoma after long term cyclophosphamide for Waldenstrom’s macroglobulinemia (AJSP 1996;20:500)
● 86 year old man with moderately differentiated adenocarcinoma of bladder, prostatic low grade neuroendocrine carcinoma and Gleason 3+3 prostatic adenocarcinoma (Archives 2004;128:e166)
● Developing at vesicocutaneous edge of vesicostomy 40 years after creation in patient with cadaveric renal transplant (Archives 2004;128:e58)
Treatment
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● Radical cystectomy
Clinical images
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with complete bladder eversion and prolapse
Gross description (Macroscopy)
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● 2/3 are solitary
● Fungating mass invades bladder wall and ulcerates the mucosa
● Tumor surface is covered by gelatinous material
Gross images
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large mass partially covered by everted and thickened bladder wall
No thumbnails: adenocarcinoma of urinary bladder, link
Micro description (Histopathology)
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● Glandular component predominates, usually resembles colonic carcinoma
● Often produces mucin, usually deeply invades muscularis propria
● Almost all are considered high grade at diagnosis
Micro images
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Well differentiated mucinous tumor
Moderately differentiated tumor
Mucinous tumor #1; #2; #3-mucicarmine
Arising from nephrogenic adenoma
Metastatic colon adenocarcinoma (fig 1) versus primary bladder adenocarcinoma #1 (fig 2); #2
No thumbnail: PSA stains metastatic prostatic adenocarcinoma
http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=009804
PSAP stains metastatic prostatic adenocarcinoma
http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=009790
Cytology description
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● High grade, but often lacks features of glandular differentiation
● Rarely is well differentiated and benign appearing
Cytology images
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Positive stains
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● CK7, CEA, EMA
● Variable CDX2 (AJSP 2003;27:303, Mod Pathol 2005;18:1217)
● Membranous staining for beta-catenin
Negative stains
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● PSA (Hum Path 1986;17:939), vimentin
● Variable PAP, CA-125 and CK20
Electron microscopy descriptions
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●
Electron microscopy images
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Molecular / cytogenetics description
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●
Molecular / cytogenetics images
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Differential Diagnosis
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● Local extension of prostatic adenocarcinoma: most prostatic adenocarcinomas are PSA+ and PAP+, negative for p63, high molecular weight cytokeratin and thrombomodulin, but bladder adenocarcinomas are opposite
● Local extension of colonic cancer: no urothelial carcinoma in situ, positive nuclear staining for beta-catenin in 81%, CK20+ in 94%, CK7 negative in 100%, thrombomodulin negative in 100%, vs. bladder adenocarcinoma: negative nuclear staining for beta-catenin in 100%, CK20+ in only 53%, CK7+ in 65%, thrombomodulin+ in 59% (AJSP 2001;25:1380, AJSP 1993;17:171)
● Metastatic disease: usually associated with known disseminated disease (but see AJSP 1990;14:877), submucosal centered, extensive vascular invasion
● Colonic metaplasia: may mimic well differentiated adenocarcinoma due to widespread involvement with dissecting mucin pools; however minimal atypia, no mitoses, no signet ring cells, usually non-infiltrative, minimal/no muscle invasion (Hum Path 1997;28:1152)
● Urothelial carcinoma with glandular features: doesn’t differentiate towards colonic mucosa, usually minimal mucin and goblet cells, “glands” are surrounded by urothelial-type cells
● Florid cystitis glandularis: no nuclear anaplasia, rarely invades muscularis propria
Additional references
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●
End of Bladder > Other Carcinomas > Adenocarcinoma
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