Bladder
Adenocarcinoma
General

Author: Rugvedita Parakh, M.D. (see Authors page)

Revised: 28 July 2016, last major update December 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Bladder [title] Adenocarcinoma

See also: urachal adenocarcinoma
Cite this page: Adenocarcinoma - General. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderadeno.html. Accessed December 9th, 2016.
Definition / General
  • Defined as malignant glandular tumor differentiated towards colonic mucosa
  • Restrict diagnosis to pure adenocarcinomas; avoid use if associated with squamous or urothelial carcinoma component
  • Epicenter is mucosa, not muscularis propria (which is found in urachal adenocarcinoma)
Epidemiology
  • Less than 2% of all bladder malignancies
  • 2/3 in men; mean age 68 years
Sites
  • Usually lateral wall or trigone of bladder
Etiology
  • Some cases may be due to progression of extensive intestinal metaplasia (cystitis glandularis); these cases arise at trigone and are usually enteric
  • Exstrophy: diffuse intestinalization; 7% develop adenocarcinoma, even after repair
  • Diverticula: usually develop urothelial carcinoma, occasionally adenocarcinoma
  • Also endometriosis, pelvic lipomatosis, Schistosoma haematobium
  • Chronic irritation of bladder, including nonfunctioning bladder
Clinical Features
  • Usually present with hematuria, rarely with mucusuria, dysuria
  • Patients are older and mucusuria is more common than in urachal adenocarcinoma
  • 5 year survival is 20-40%
Prognostic Factors
  • Stage is most important prognostic feature
  • Compared to urothelial carcinoma, patients present at more advanced stage, but have similar prognosis (Urology 2010;75:376)
Case Reports
Treatment
  • Radical cystectomy
  • Adjuvant therapy may be given in some cases
Gross Description
  • 2/3 are solitary
  • Tumor surface is covered by gelatinous material
Gross Images

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Adenocarcinoma of urinary bladder

Micro Description
  • Glandular component predominates, usually resembles colonic carcinoma
  • Often produces mucin, usually deeply invades muscularis propria
  • Almost all are considered high grade at diagnosis
  • Other patterns include mucinous, signet ring, hepatoid, mixed
  • Associated with in-situ component
  • Intestinal metaplasia may be seen
Micro Images

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Moderately differentiated adenocarcinoma

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Rectosigmoid adenocarcinoma

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Mucinous tumors

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With villous adenoma

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Arising from nephrogenic adenoma


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Metastatic colon adenocarcinoma

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Secondary colorectal adenocarcinoma versus primary bladder adenocarcinoma (CDX2, villin, AMACR)

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Prostatic tumors invading bladder

Cytology Description
  • High grade, but often lacks features of glandular differentiation
  • Rarely is well differentiated and benign appearing
Cytology Images

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Penile metastasis

Positive Stains
Negative Stains
Differential Diagnosis