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Bladder
Benign tumors
Villous adenoma
Author: Nat Pernick, M.D. (see Authors page)
Revised: 28 February 2010, last major update February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Rare bladder tumor similar to colonic counterpart
Terminology
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● Also called villous tumors
Epidemiology
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● Rare
● Typically elderly patients, no gender preference
● Wide age range, but usually 40-70 years
Sites
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● Arise throughout urinary tract, but most common in bladder
● Arises in urachus, dome or trigone
Etiology
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●
Clinical features
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● Hematuria, mucusuria and irritative symptoms
● May be associated with in situ or invasive adenocarcinoma at diagnosis, less often with in situ or invasive urothelial carcinoma
Prognostic factors
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● Excellent prognosis if isolated, poorer if only in-situ adenocarcinoma and well sampled, poorest if in situ or invasive urothelial carcinoma (Hum Path 2002;33:236)
Case reports
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● Arising in background of chronic cystitis, aneuploid (Mod Path 1999;12:735)
● 62 year old woman with tumor in augmented bladder 44 years after surgery (Int J Urol 2006;13:1134)
● 66 year old man with tumor in urinary diversion pouch (Int J Urol 2007;14:865)
● 75 year old man with coexisting mucinous adenocarcinoma (J Clin Pathol 2003;56:465)
Treatment
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● Excision
● Excellent prognosis if isolated (AJSP 1999;23:764)
Clinical images
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Gross description (Macroscopy)
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● Resembles papillary urothelial carcinoma
Gross images
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Micro description (Histopathology)
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● Resembles colonic villous adenoma with pointed processes lined by pseudostratified columnar epithelium with nuclear stratification, nuclear crowding, nuclear hyperchromasia, occasional prominent nucleoli, occasional mitoses
● Associated with cystitis glandularis and cystitis cystica
● MUST sample entire lesion to rule out adenocarcinoma (in situ or invasive)
Micro images
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Arising in urachal Finger-like projections Resembles colonic With mucinous
cyst adenoma adenocarcinoma
Papillary fronds covered by columnar AFIP Fig 2-52: Polypoid and villous adenoma
epithelium with goblet cells, and arising at bladder dome
nuclear crowding and stratification
With carcinoma in situ
Cytology description
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Cytology images
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Positive stains
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● Acidic mucins (Alcian blue), CK20, CEA (luminal, 89%)
● CK7 (56%), EMA (22%); variable prostate specific membrane antigen (Am J Surg Pathol 2008;32:1322)
Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Well-differentiated colonic adenocarcinoma extending into bladder: clinical history, definite invasion
Additional references
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End of Bladder > Benign tumors > Villous adenoma
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