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Other Carcinomas

Adenocarcinoma - in situ

Reviewers: Rugvedita Parakh, M.D., HCG Oncology (see Reviewers page)
Revised: 6 June 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.


● Primary noninvasive adenocarcinoma of bladder
● Findings below are for patients without concurrent invasive adenocarcinoma or villous adenoma


● Also called noninvasive urothelial carcinoma with glandular differentiation (Am J Surg Pathol 2009;33:1241)

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

Micro 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

Micro images

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

End of Bladder > Other Carcinomas > Adenocarcinoma in situ

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