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Bladder

Other Carcinomas

Adenocarcinoma – in situ

 

Author: Nat Pernick, M.D. (see Authors page)

Revised: 22 December 2009, UPDATE IN PROGRESS

Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.

 

Definition

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● Rare lesion found alone or with invasive adenocarcinoma

 

Terminology

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Epidemiology

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Sites

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Etiology

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● Associated with cystitis glandularis; may also be due to urachus (Am J Surg Pathol 2002;26:271)

 

Clinical features

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Prognostic factors

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Case reports

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Treatment

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Clinical images

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Findings below are for patients without concurrent invasive adenocarcinoma or villous adenoma:

Mean age 70 years, 79% male

Associated with urothelial CIS or papillary urothelial carcinoma without invasion

74% had or developed invasive carcinoma, including high incidence of micropapillary and small cell urothelial carcinomas (AJSP 2001;25:892)

 

Gross description (Macroscopy)

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Gross images

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Micro description (Histopathology)

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Papillary (J Urol 1985;134:544), flat and cribriform architecture with atypical columnar epithelium, often with apical cytoplasm

True glandular differentiation (by definition)

● Moderate to severe nuclear pleomorphism, apoptosis, 5+ mitotic figures/10 HPF

● Noninvasive (by definition), using analogous criteria for invasion in GI tract (noninvasive glands lack a desmoplastic or associated inflammatory stromal reaction; base of lesion is parallel to basement membrane of adjacent uninvolved mucosa; no single cells or isolated poorly formed glands)

● Some authors require derivation from glandular cells (cystitis glandularis)

● Associated with villous adenoma (Hum Pathol 2002;33:236) and invasive urothelial carcinoma, particularly micropapillary and small cell types

 

Micro images

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Villous adenoma with anaplasia bordering on carcinoma in situ #1#2

 

Cytology description

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Cytology images

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Positive stains

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● Variable P501S (prostein) and PSMA (prostate specific membrane antigen, Am J Surg Pathol 2008;32:1322)

 

Negative  stains

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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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Noninvasive urothelial carcinoma with glandular differentiation (Am J Surg Pathol 2009;33:1241, Mod Pathol 2009;22:1280)

● Urothelial carcinoma with gland-like lumina: has small cystic spaces containing mucin, not lined by columnar epithelium

 

Additional references

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End of Bladder > Other Carcinomas > Adenocarcinoma – in situ

 

 

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