Bladder, ureter & renal pelvis
Glandular neoplasms

Topic Completed: 1 December 2014

Minor changes: 27 April 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Bladder [title] adenocarcinoma

See also: Urachal adenocarcinoma

Rugvedita Parakh, M.D.
Page views in 2020: 6,936
Page views in 2021 to date: 3,111
Cite this page: Parakh R. Adenocarcinoma. website. Accessed May 8th, 2021.
Definition / general
  • Defined as malignant glandular tumor differentiated towards colonic mucosa
  • Restrict diagnosis to pure adenocarcinomas; avoid use if associated with squamous or urothelial carcinoma component
  • Epicenter is mucosa, not muscularis propria (which is found in urachal adenocarcinoma)
  • Less than 2% of all bladder malignancies
  • 2/3 in men; mean age 68 years
  • Usually lateral wall or trigone of bladder
  • Some cases may be due to progression of extensive intestinal metaplasia (cystitis glandularis); these cases arise at trigone and are usually enteric
  • Exstrophy: diffuse intestinalization; 7% develop adenocarcinoma, even after repair
  • Diverticula: usually develop urothelial carcinoma, occasionally adenocarcinoma
  • Also endometriosis, pelvic lipomatosis, Schistosoma haematobium
  • Chronic irritation of bladder, including nonfunctioning bladder
Clinical features
  • Usually present with hematuria, rarely with mucusuria, dysuria
  • Patients are older and mucusuria is more common than in urachal adenocarcinoma
  • 5 year survival is 20-40%
Prognostic factors
  • Stage is most important prognostic feature
  • Compared to urothelial carcinoma, patients present at more advanced stage, but have similar prognosis (Urology 2010;75:376)
Case reports
  • Radical cystectomy
  • Adjuvant therapy may be given in some cases
Gross description
  • 2/3 are solitary
  • Tumor surface is covered by gelatinous material
Gross images

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Adenocarcinoma of urinary bladder

Microscopic (histologic) description
  • Glandular component predominates, usually resembles colonic carcinoma
  • Often produces mucin, usually deeply invades muscularis propria
  • Almost all are considered high grade at diagnosis
  • Other patterns include mucinous, signet ring, hepatoid, mixed
  • Associated with in situ component
  • Intestinal metaplasia may be seen
Microscopic (histologic) images

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Arising from nephrogenic adenoma

Secondary colorectal adenocarcinoma versus primary bladder adenocarcinoma (villin, AMACR)

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Prostatic tumors invading bladder

Cytology description
  • High grade, but often lacks features of glandular differentiation
  • Rarely is well differentiated and benign appearing
Cytology images

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Penile metastasis

Positive stains
Negative stains
Differential diagnosis
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