Bladder & ureters
Adenocarcinoma
Adenocarcinoma in situ


Topic Completed: 1 December 2014

Revised: 26 June 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Adenocarcinoma in situ [title] bladder

Rugvedita Parakh, M.D.
Page views in 2018: 590
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Cite this page: Parakh R. Adenocarcinoma in situ. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderadenoinsitu.html. Accessed December 7th, 2019.
Definition / general
  • Primary noninvasive adenocarcinoma of bladder
  • Findings below are for patients without concurrent invasive adenocarcinoma or villous adenoma
Terminology
Clinical features
  • Mean age 70 years, 75% male
  • Associated with urothelial CIS or papillary urothelial carcinoma without invasion
  • 50-74%% developed invasive carcinoma, including high incidence of poorly differentiated, micropapillary and small cell urothelial carcinoma (Am J Surg Pathol 2001;25:892)
Treatment
  • Transurethral excision; intravesical chemotherapy; intravesical bCG
Gross description
  • Exophytic, papillary to flat
Microscopic (histologic) description
  • Papillary, flat, and cribriform architecture
  • Neoplastic cells are columnar with luminal cytoplasm with occasional intracytoplasmic mucin
  • True glandular differentiation (by definition)
  • Moderate to severe nuclear pleomorphism, apoptosis, 5+ mitotic figures/10 HPF
  • Noninvasive, by definition
  • Often associated with other urothelial carcinoma patterns including small cell, micropapillary and poorly differentiated
  • Rare necrosis
  • Not commonly associated with invasive adenocarcinoma
Microscopic (histologic) images

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Villous adenoma with marked atypia

Differential diagnosis
  • Urothelial carcinoma in situ: no invasion, no glandular formation, no/rare intracytoplasmic mucin
  • Urothelial carcinoma with gland like spaces: invasive, no true glandular formation, no/rare intracytoplasmic mucin
  • Florid cystitis glandularis with or without intestinal metaplasia: insufficient atypia to diagnosis as carcinoma in situ
  • Villous adenoma: insufficient atypia to diagnosis as carcinoma in situ
  • Noninvasive micropapillary carcinoma: has characteristic retraction-like spaces; no glandular formation, no/rare intracytoplasmic mucin
  • Clear cell adenocarcinoma: invasive, hobnail cells
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