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Bladder

Urothelial carcinoma - invasive

Signet ring cell adenocarcinoma


Reviewer: Nat Pernick, M.D., PathologyOutlines.com, Inc. (see Reviewers page)
Revised: 28 June 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Uncommon tumor with signet ring type cells with intracytoplasmic mucin
● Recommended to limit diagnosis to cases with 25% or more signet ring tumor cells

Epidemiology
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● Usually men, median age 58 years (Am J Clin Pathol 1991;95:13)

Clinical features
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● Diffuse infiltration, similar to linitis plastica of stomach, makes resection for cure virtually impossible
● Very aggressive with poorer survival (World J Urol 2011 Jun 25 [Epub ahead of print]); however, presence of a few signet ring cells doesn’t affect the prognosis of a bladder adenocarcinoma

Treatment
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● Cystectomy may be important for improved survival (Urol Int 2011;86:453)

Gross description
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● Usually nonurachal
● May lack mucosal involvement
● Diffusely infiltrative

Micro description
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● Signet ring type cells with intracytoplasmic mucin, resembling lobular carcinoma of breast but larger
● May have monocytoid cells with central nuclei
● Urothelial abnormalities may be difficult to find
● No abundant extracellular mucin

Micro images
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Various images

Positive stains
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● Cytokeratin; usually mucin, but may not be prominent

Differential diagnosis
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● Direct extension from prostatic or rectal adenocarcinoma
● Metastasis from stomach, breast or other organs
● Nodular histiocytic hyperplasia: rare, one case in lamina propria of bladder, may have mild atypia and mitoses; strong CD68+, keratin- (Am J Surg Pathol 1998;22:285)

End of Bladder > Urothelial carcinoma - invasive > Signet ring cell adenocarcinoma


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