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bladder adenocarcinoma

Thursday 5 August 2021

Adenocarcinoma of the urinary bladder

PO

Types

- Intestinal type (or enteric type):

  • Resembles colonic adenocarcinoma (Cancer 1991;67:2165)
  • Neoplastic glands are lined by pleomorphic mucin producing pseudostratified columnar epithelium
  • Central dirty necrosis is commonly seen

- Mucinous (colloid) type:

  • Nests of neoplastic cells floating in abundant extravasated mucin
  • Singly dispersed or groups of signet ring cells can be seen in the mucin pools
  • Mucin usually deeply invades muscularis propria

- Signet ring cell type (diffuse poorly differentiated adenocarcinoma):

  • Discohesive round cells with large intracellular mucin vacuoles displacing nuclei to the periphery without extracellular mucin
  • Diffusely infiltrating stromal tissue

- Association with in situ component is an important clue to differentiate primary adenocarcinoma of the bladder from secondary adenocarcinoma involving the bladder

- Intestinal metaplasia or villous adenoma may be seen

IHC

- CK7 (variable)
- CK20 (variable)
- CEA
- EMA
- villin
- Variable CDX2 (Am J Surg Pathol 2003;27:303, Mod Pathol 2005;18:1217)
Membranous staining for beta-catenin

Differential diagnosis

- colonic metaplasia :

  • may mimic well differentiated adenocarcinoma due to widespread involvement with dissecting mucin pools; however minimal atypia, no mitoses, no signet ring cells, usually non-infiltrative, minimal/no muscle invasion (Hum Pathol 1997;28:1152)

- florid cystitis glandularis :

  • no nuclear anaplasia, rarely invades muscularis propria

- local extension of colonic cancer:

  • no urothelial carcinoma in situ, positive nuclear staining for beta-catenin in 81%, CK20+ in 94%, CK7 negative in 100%, thrombomodulin negative in 100%, vs. bladder adenocarcinoma which has negative nuclear staining for beta-catenin in 100%, CK20+ in only 53%, CK7+ in 65%, thrombomodulin+ in 59% (Am J Surg Pathol 2001;25:1380, Am J Surg Pathol 1993;17:171)

- local extension of prostatic adenocarcinoma:

  • most prostatic adenocarcinomas are PSA+ and PAP+, negative for p63, high molecular weight cytokeratin and thrombomodulin, but bladder adenocarcinomas are opposite

- metastatic disease : usually associated with known disseminated disease (Hum Pathol 1997;28:1152), submucosal centered, extensive vascular invasion
Mullerianosis

- urothelial carcinoma with glandular features: doesn’t differentiate towards colonic mucosa, usually minimal mucin and goblet cells, “glands” are surrounded by urothelial-type cells