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Bladder

Other carcinomas

Metastases


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 14 May 2011, last major update May 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

General
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● Most common primaries are breast and melanoma; also lung, pancreas, ovary and stomach
● Associated with widely disseminated disease
● Urothelium is usually spared
● Tumors may also arise from local extension from prostate, uterine cervix or rectum
● Difficult to distinguish bladder adenocarcinoma morphologically from extension of colonic adenocarcinoma
● Renal cell metastases: rare (<40 reported cases); usually men age 35-69 years who present with gross hematuria or urinary obstruction if tumor is in bladder neck; metastases also present in other organs; poor prognosis (Mod Pathol 1999;12:351); may be due to hematogenous spread, retrograde spread from renal vein or renal hilar lymphatics or direct intraluminal transit

Case reports
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● 45 year old woman with metastasis from appendiceal mucinous adenocarcinoma (BMC Cancer 2010, 10:62)
● 67 year old woman with colonic metastasis (Surg Today 2010;40:1093)
● 68 year old woman with metastasis from breast cancer (J Clin Oncol 2007;25:4308)
● 90 year old woman with metastasis of gastric cancer (World J Surg Oncol 2005;3:55)
● Bladder metastases of melanoma (Med Oncol 2010 Nov 2 [Epub ahead of print]), Arch Esp Urol 2002;55:1277)
● Bladder metastasis from pancreatic adenocarcinoma (Urol Radiol 1992;13:187)
● Bladder metastasis from renal cell carcinoma (J Urol 2010;184:726, Urologe A 2010;49:407, Can J Urol 2009;16:4611, Int J Urol 2003;10:453)

Micro description
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● Morphology varies based on the primary tumor
● Metastatic renal cell carcinoma: delicate fibrovascular stroma with abundant sinusoidal vessels; nests of polygonal cells with abundant clear cytoplasm and nuclei ranging from small and hyperchromatic with inconspicuous nucleoli to large irregular nuclei with prominent nucleoli; may resemble urothelial carcinoma with clear cell features

Micro images
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Metastatic appendiceal mucinous adenocarcinoma-various images


Metastatic breast cancer: H&E, PR, HER2

   
Metastatic seminoma

Positive stains
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● Breast: positive for ER/PR
● Lung: positive for TTF1
● Renal cell: CAM 5.2, vimentin, Leu-M1 (CD15); negative for CK7, CK20, 34betaE12, CEA, S100, HMB45, chromogranin

Differential diagnosis
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Colorectal carcinoma (extension): positive for CK20, villin, beta-catenin (nuclear)
Prostatic adenocarinoma (extension): positive for PSA, PSAP, AMACR, Leu7
Urothelial carcinoma with glandular differentiation: positive for CK7, CK20, 34betaE12, Uroplakin, Thrombomodulin

Additional references
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Histopathology 2010 Sep 21 [Epub ahead of print]

End of Bladder > Other carcinomas > Metastases


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