Adenocarcinoma - in situ

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

Revised: 28 July 2016, last major update December 2014

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

PubMed Search: Adenocarcinoma in situ [title] bladder
Cite this page: Adenocarcinoma in situ. website. Accessed November 18th, 2018.
Definition / general
  • Primary noninvasive adenocarcinoma of bladder
  • Findings below are for patients without concurrent invasive adenocarcinoma or villous adenoma
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)
  • 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