Bladder - Urothelial carcinoma with glandular differentiation

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Urothelial carcinoma with glandular differentiation

Reviewer: Rugvedita Parakh, Cedars-Sinai Medical Center, Los Angeles, California

Revised: 6 June 2010, last major update June 2010

Definition

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● Predominant features of urothelial carcinoma, but with distinct glands (i.e. a mixed tumor)

Terminology

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● Similar to urothelial carcinoma with gland-like lumens (not a WHO diagnosis, but considered by AFIP Series 4 to be the same as microcystic variant)

Clinical features

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● 7% of urothelial carcinomas have squamous or glandular differentiation, which is associated with higher stage at presentation (Int Urol Nephrol 2001;33:631, Int Urol Nephrol 2007;39:803)

● Note: mucoid cytoplasmic inclusions are present in up to 37% of urothelial carcinomas, often high grade, but this is not considered to represent glandular differentiation (Hum Pathol 1992;23:860)

● Report as urothelial carcinoma with glandular differentiation, and estimate the percentage of the glandular component

● 50% of noninvasive tumors with glandular differentiation became invasive, but none developed adenocarcinoma (Am J Surg Pathol 2009;33:1241)

Micro description (Histopathology)

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● Urothelial carcinoma with focal true glands with goblet cells or colonic epithelium and mucin

● Distinction between true glands with glandular lumens (with colonic epithelium or goblet cells) and gland-like lumens (lacking these cells) appears to have no clinical significance if overlying pattern is clearly urothelial

Micro images

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Urothelial differentiation is seen in the Fig 1D: H&E Fig 4: CK7+

cells surrounding the gland-like spaces

Positive stains

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● CK7, CK20

Negative stains

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● Villin

Differential Diagnosis

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● Adenocarcinoma: no urothelial component; tumor of pure glandular components with glands lined by goblet cells or intestinal cells, not flattened urothelial-like cells; usually deeply invasive, high grade

● Colonic adenocarcinoma: CK7-, villin+ (Arch Pathol Lab Med 2002;126:1057)

● Cystitis cystica / glandularis: glands in lamina propria lined by columnar, cuboidal or intestinal epithelium; no atypia, no mitotic figures, no necrosis

● Müllerianosis: presence of 2 of 3 (endocervicosis, endometriosis or endosalpingiosis); no atypia, no mitotic figures

● Nephrogenic metaplasia / adenoma: small hollow tubules similar to mesonephric tubules, usually lined by single layer of bland cuboidal or hobnail cells, surrounding eosinophilic or basophilic secretions; no/minimal atypia or mitotic figures; no true invasion

● Urothelial carcinoma, microcystic variant: not true glands, lumens are lined by flattened or columnar epithelium, not goblet cells or colonic epithelium; lumens contain granular debris or necrotic cells, occasionally mucin

End of Bladder > Urothelial carcinoma with glandular differentiation

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