Difference between revisions of "Adenocarcinoma of the urinary bladder"
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| Micro = nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - '''essential''' | | Micro = nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - '''essential''' | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[urachal carcinoma]], invasive [[urothelial carcinoma]] with glandular differentiation, [[metastatic]] adenocarcinoma (esp. [[colorectal adenocarcinoma]]) | | LMDDx = [[urachal carcinoma]], invasive [[urothelial carcinoma]] with glandular differentiation, [[metastatic]] adenocarcinoma, direct extension of [[adenocarcinoma]] from an adjacent structure (esp. [[colorectal adenocarcinoma]]) | ||
| Stains = | | Stains = | ||
| IHC = CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin | | IHC = CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin -ve (nuclei -ve, membranes +ve) | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 19: | Line 19: | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = +/-hematuria | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = rare | | Prevalence = rare | ||
| Line 44: | Line 44: | ||
**Frequently looks just like [[colorectal adenocarcinoma]]. | **Frequently looks just like [[colorectal adenocarcinoma]]. | ||
*Without urothelial differentiation - '''essential'''.<ref name=pmid23451748>{{Cite journal | last1 = Zhong | first1 = M. | last2 = Gersbach | first2 = E. | last3 = Rohan | first3 = SM. | last4 = Yang | first4 = XJ. | title = Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance. | journal = Arch Pathol Lab Med | volume = 137 | issue = 3 | pages = 371-81 | month = Mar | year = 2013 | doi = 10.5858/arpa.2012-0076-RA | PMID = 23451748 }}</ref> | *Without urothelial differentiation - '''essential'''.<ref name=pmid23451748>{{Cite journal | last1 = Zhong | first1 = M. | last2 = Gersbach | first2 = E. | last3 = Rohan | first3 = SM. | last4 = Yang | first4 = XJ. | title = Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance. | journal = Arch Pathol Lab Med | volume = 137 | issue = 3 | pages = 371-81 | month = Mar | year = 2013 | doi = 10.5858/arpa.2012-0076-RA | PMID = 23451748 }}</ref> | ||
*+/-Evidence of invasion such as: | |||
**[[Desmoplastic stroma]]. | |||
**Extensive disordered or cribriform growth. | |||
Subtypes:<ref name=pmid23772302>{{Cite journal | last1 = Abbas | first1 = M. | last2 = Kramer | first2 = MW. | last3 = Wolters | first3 = M. | last4 = Herrman | first4 = TR. | last5 = Becker | first5 = JU. | last6 = Kreipe | first6 = HH. | title = Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case. | journal = Rare Tumors | volume = 5 | issue = 1 | pages = e3 | month = Feb | year = 2013 | doi = 10.4081/rt.2013.e3 | PMID = 23772302 }}</ref> | Subtypes:<ref name=pmid23772302>{{Cite journal | last1 = Abbas | first1 = M. | last2 = Kramer | first2 = MW. | last3 = Wolters | first3 = M. | last4 = Herrman | first4 = TR. | last5 = Becker | first5 = JU. | last6 = Kreipe | first6 = HH. | title = Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case. | journal = Rare Tumors | volume = 5 | issue = 1 | pages = e3 | month = Feb | year = 2013 | doi = 10.4081/rt.2013.e3 | PMID = 23772302 }}</ref> | ||
| Line 51: | Line 54: | ||
*Signet ring cell carcinoma. | *Signet ring cell carcinoma. | ||
*Clear cell carcinoma (also ''[[mesonephroid carcinoma]]''). | *Clear cell carcinoma (also ''[[mesonephroid carcinoma]]''). | ||
Note: | |||
*The presence of [[adenocarcinoma in situ]] suggests the lesion arose in the bladder.{{fact}} | |||
DDx: | DDx: | ||
*[[Urachal | *[[Urachal adenocarcinoma]] - dome of bladder. | ||
*Invasive [[urothelial carcinoma]] with glandular differentiation - has urothelial differentiation. | *Invasive [[urothelial carcinoma]] with glandular differentiation - has urothelial differentiation. | ||
*[[Metastatic]] adenocarcinoma | *[[Metastatic]] adenocarcinoma ''or'' extension of [[adenocarcinoma]] from a nearby structure | ||
**[[Colorectal adenocarcinoma]]. | **[[Colorectal adenocarcinoma]]. | ||
**[[Prostatic adenocarcinoma]] - esp. [[ductal adenocarcinoma of the prostate]]. | |||
**[[Endometrioid endometrial adenocarcinoma]]. | |||
*[[Tubular adenoma of the urinary tract]].<ref name=pmid23664485>{{Cite journal | last1 = Kao | first1 = CS. | last2 = Epstein | first2 = JI. | title = Tubular adenoma of the urinary tract: a newly described entity. | journal = Hum Pathol | volume = 44 | issue = 9 | pages = 1890-4 | month = Sep | year = 2013 | doi = 10.1016/j.humpath.2013.02.017 | PMID = 23664485 }}</ref> | |||
===Images=== | ===Images=== | ||
====Case 1==== | ====Case 1==== | ||
<gallery> | <gallery> | ||
Image: Adenocarcinoma of the urinary bladder -- low mag.jpg | AUB - low mag. (WC) | Image: Adenocarcinoma of the urinary bladder -- low mag.jpg | Invasive AUB - low mag. (WC) | ||
Image: Adenocarcinoma of the urinary bladder -- intermed mag.jpg | AUB - intermed. mag. (WC) | Image: Adenocarcinoma of the urinary bladder -- intermed mag.jpg | Invasive AUB - intermed. mag. (WC) | ||
Image: Adenocarcinoma of the urinary bladder -- high mag.jpg | AUB - high mag. (WC) | Image: Adenocarcinoma of the urinary bladder -- high mag.jpg | Invasive AUB - high mag. (WC) | ||
</gallery> | |||
====Case 2 - AIS==== | |||
<gallery> | |||
Image: Adenocarcinoma in situ of bladder -- very low mag.jpg | Adenocarcinoma in situ (AIS) - very low mag. | |||
Image: Adenocarcinoma in situ of bladder -- low mag.jpg | AIS - low mag. | |||
Image: Adenocarcinoma in situ of bladder -- intermed mag.jpg | AIS - intermed. mag. | |||
Image: Adenocarcinoma in situ of bladder -- high mag.jpg | AIS - high mag. | |||
</gallery> | </gallery> | ||
| Line 71: | Line 88: | ||
*CK20 +ve. | *CK20 +ve. | ||
*CDX2 +ve (strong, diffuse). | *CDX2 +ve (strong, diffuse). | ||
*Beta-catenin | *Beta-catenin -ve (negative nuclear staining, positive membranous staining). | ||
**[[Colorectal adenocarcinoma]] typically has nuclear staining ''and'' membranous staining. | **[[Colorectal adenocarcinoma]] typically has nuclear staining ''and'' membranous staining. | ||
*Thrombomodulin +ve/-ve (~60% of cases). | *Thrombomodulin +ve/-ve (~60% of cases). | ||
| Line 85: | Line 102: | ||
Image: Adenocarcinoma of the urinary bladder - beta-catenin -- very high mag.jpg | AUB - beta-catenin - very high mag. (WC) | Image: Adenocarcinoma of the urinary bladder - beta-catenin -- very high mag.jpg | AUB - beta-catenin - very high mag. (WC) | ||
</gallery> | </gallery> | ||
==Sign out== | |||
<pre> | |||
Urinary Bladder Tumour, Transurethral Resection: | |||
- Invasive adenocarcinoma into the lamina propria, see comment. | |||
- Muscularis propria not sampled. | |||
- Negative for lymphovascular invasion. | |||
Comment: | |||
No urothelial carcinoma component is identified. | |||
The differential diagnosis includes (1) primary adenocarcinoma of the | |||
bladder, (2) adenocarcinoma from another organ (direct extension or | |||
metastasis), (3) urothelial carcinoma with glandular differentiation | |||
without sampled urothelial carcinoma, and (4) urachal adenocarcinoma. | |||
Immunostaining of the tumour is as follows: | |||
POSITIVE: CK7, CK20, CK34betaE12. | |||
NEGATIVE: beta-catenin (membranous pattern only, nuclei are negative). | |||
The immunoprofile (beta-catenin = nuclei negative, CK7 = positive) and | |||
presence of an in situ component favours a primary adenocarcinoma of | |||
the bladder; however, this is uncommon. Nonprimary adenocarcinoma | |||
(e.g. colorectal adenocarcinoma) should be excluded clinically. | |||
</pre> | |||
==See also== | ==See also== | ||
Latest revision as of 18:14, 2 November 2016
| Adenocarcinoma of the urinary bladder | |
|---|---|
| Diagnosis in short | |
 Adenocarcinoma of the urinary bladder. H&E stain. | |
|
| |
| Synonyms | primary adenocarcinoma of the urinary bladder |
|
| |
| LM | nuclear pleomorphism (may be mild), usually glandular differentiation (most common), no urothelial differentiation - essential |
| LM DDx | urachal carcinoma, invasive urothelial carcinoma with glandular differentiation, metastatic adenocarcinoma, direct extension of adenocarcinoma from an adjacent structure (esp. colorectal adenocarcinoma) |
| IHC | CK7 +ve, CK20 +ve, CDX2 +ve (strong, diffuse), beta-catenin -ve (nuclei -ve, membranes +ve) |
| Grossing notes | radical cystectomy grossing, cystoprostatectomy grossing |
| Site | urinary bladder |
|
| |
| Signs | +/-hematuria |
| Prevalence | rare |
| Treatment | cystectomy |
Adenocarcinoma of the urinary bladder, also primary adenocarcinoma of the urinary bladder and bladder adenocarcinoma, is a very uncommon malignant urinary bladder tumour.
General
Clinical:
- Like urothelial carcinoma - usually hematuria.[1]
Microscopic
Features:
- Nuclear pleomorphism - may be mild.
- Usually glandular differentiation (most common).
- Frequently looks just like colorectal adenocarcinoma.
- Without urothelial differentiation - essential.[3]
- +/-Evidence of invasion such as:
- Desmoplastic stroma.
- Extensive disordered or cribriform growth.
Subtypes:[2]
- Glandular.
- Papillary.
- Colloidal (mucinous).
- Signet ring cell carcinoma.
- Clear cell carcinoma (also mesonephroid carcinoma).
Note:
- The presence of adenocarcinoma in situ suggests the lesion arose in the bladder.[citation needed]
DDx:
- Urachal adenocarcinoma - dome of bladder.
- Invasive urothelial carcinoma with glandular differentiation - has urothelial differentiation.
- Metastatic adenocarcinoma or extension of adenocarcinoma from a nearby structure
- Tubular adenoma of the urinary tract.[4]
Images
Case 1
Invasive AUB - low mag. (WC)
Invasive AUB - intermed. mag. (WC)
Invasive AUB - high mag. (WC)
Case 2 - AIS
Adenocarcinoma in situ (AIS) - very low mag.
AIS - low mag.
AIS - intermed. mag.
AIS - high mag.
IHC
Features - variable:[5]
- CK7 +ve.
- CK20 +ve.
- CDX2 +ve (strong, diffuse).
- Beta-catenin -ve (negative nuclear staining, positive membranous staining).
- Colorectal adenocarcinoma typically has nuclear staining and membranous staining.
- Thrombomodulin +ve/-ve (~60% of cases).
- Colorectal adenocarcinoma -ve.
- Urothelial carcinoma +ve (~90% of cases).
Images
Case 1
AUB - beta-catenin - low mag. (WC)
AUB - beta-catenin - intermed. mag. (WC)
AUB - beta-catenin - high mag. (WC)
AUB - beta-catenin - very high mag. (WC)
Sign out
Urinary Bladder Tumour, Transurethral Resection: - Invasive adenocarcinoma into the lamina propria, see comment. - Muscularis propria not sampled. - Negative for lymphovascular invasion. Comment: No urothelial carcinoma component is identified. The differential diagnosis includes (1) primary adenocarcinoma of the bladder, (2) adenocarcinoma from another organ (direct extension or metastasis), (3) urothelial carcinoma with glandular differentiation without sampled urothelial carcinoma, and (4) urachal adenocarcinoma. Immunostaining of the tumour is as follows: POSITIVE: CK7, CK20, CK34betaE12. NEGATIVE: beta-catenin (membranous pattern only, nuclei are negative). The immunoprofile (beta-catenin = nuclei negative, CK7 = positive) and presence of an in situ component favours a primary adenocarcinoma of the bladder; however, this is uncommon. Nonprimary adenocarcinoma (e.g. colorectal adenocarcinoma) should be excluded clinically.
See also
References
- ↑ 1.0 1.1 Ranadive, NU.; Trivedi, VD.; Gadgil, NM. (Oct 1999). "Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view.". Arch Esp Urol 52 (8): 906-11. PMID 11762445.
- ↑ 2.0 2.1 Abbas, M.; Kramer, MW.; Wolters, M.; Herrman, TR.; Becker, JU.; Kreipe, HH. (Feb 2013). "Adenocarcinoma of the urinary bladder, mesonephroid type: a rare case.". Rare Tumors 5 (1): e3. doi:10.4081/rt.2013.e3. PMID 23772302.
- ↑ Zhong, M.; Gersbach, E.; Rohan, SM.; Yang, XJ. (Mar 2013). "Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance.". Arch Pathol Lab Med 137 (3): 371-81. doi:10.5858/arpa.2012-0076-RA. PMID 23451748.
- ↑ Kao, CS.; Epstein, JI. (Sep 2013). "Tubular adenoma of the urinary tract: a newly described entity.". Hum Pathol 44 (9): 1890-4. doi:10.1016/j.humpath.2013.02.017. PMID 23664485.
- ↑ Roy, S.; Parwani, AV. (Dec 2011). "Adenocarcinoma of the urinary bladder.". Arch Pathol Lab Med 135 (12): 1601-5. doi:10.5858/arpa.2009-0713-RS. PMID 22129192.