Bladder - Clear cell adenocarcinoma

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Bladder

Other Carcinomas

Clear cell adenocarcinoma

Reviewers: Rugvedita Parakh, M.D., HCG Oncology (see Reviewers page)
Revised: 3 July 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Morphological variant of adenocarcinoma of bladder
● Resembles clear cell carcinoma (mullerian type) of female genital tract

Terminology
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● Also called mesonephric or mesonephroid carcinoma / adenocarcinoma

Etiology
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● Either arises from mullerian elements in the bladder (endometriosis), represents a peculiar variant of vesical adenocarcinoma of nonmullerian derivation, or represents a peculiar morphologic expression of urothelial carcinoma, with glandular differentiation often uncertain (Am J Surg Pathol 2002;190)

Clinical features
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● Usually women, in bladder or urethra
● Often high stage at diagnosis; stage is important prognostic factor

Case Reports
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● 35 year old woman with endometriosis (Mod Pathol 1993;6:225)
● 70 year old woman with multiple recurrences of nephrogenic metaplasia of the urinary bladder and subsequent clear cell adenocarcinoma (Hum Pathol 2006;37:117)

Gross description
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● Usually papillary, also sessile
● If presents as polypoidal growth, frequent ulceration is seen

Micro description
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● Often papillary or tubulocystic (Am J Surg Pathol 1985;9:816)
● Flat or cuboidal neoplastic cells have abundant clear or eosinophilic cytoplasm with glycogen and frequent hobnailing
● More pleomorphic cells and more mitotic figures than adenomatoid tumor; variable necrosis
● Resembles urothelial carcinoma more than adenocarcinoma
● The papillae sometimes have hyalinized cores
● Myxoid stroma may be seen

Micro images
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Papillary tumor with prominent hobnailing

Tubules and nests of cells with clear cytoplasm

Prominent papillary component with focal eosinophilic cytoplasm

Various images

Positive stains
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● CA125 (strong), CK7 (usually strong), Ki-67, p53, CEA, PAX2, PAX8, Racemase (AMACR)

Negative stains
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● CK20 (occasional positivity is noted), PSA, ER, PR (Clin Cancer Res 2008;14:1947)

Differential diagnosis
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● Nephrogenic metaplasia: young age, history of GU trauma, minimal atypia or pleomorphism, no/rare mitotic figures, no necrosis, no infiltrative growth
● Extension or metastasis from gynecologic or other clear cell carcinoma: Hum Pathol 1996;27:248, Appl Immunohistochem Mol Morphol 2010;18:396
● Urothelial carcinoma with clear cytoplasm:
● Diffuse large B cell lymphoma: Indian J Pathol Microbiol 2010;53:8790

End of Bladder > Other Carcinomas > Clear cell adenocarcinoma

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