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bladder adenocarcinoma

Thursday 5 August 2021

PO

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