Primary adenocarcinoma of the urinary bladder: a study of 6 cases from the pathologist's point of view

Abstract

Objective: The clinical presentation of adenocarcinoma is not different from the usual transitional cell carcinoma, hence the histological diagnosis plays an important role in the interpretation of cystoscopic biopsies. Six cases of primary adenocarcinoma of the urinary bladder are described from the pathologist's point of view. The diagnostic problems encountered in these cases are highlighted.

Methods: 6 cases of primary adenocarcinoma of the urinary bladder were encountered from 1983 to 1997. Relevant clinical data were analyzed. Multiple sections from the tumor and adjoining areas of the bladder were studied. Five patients were aged 50 to 75 years and the youngest patient was 22 years old.

Results: Hematuria and retention of urine were common presenting symptoms. Histologically, the diagnostic problems faced were mucinous metaplasia vs mucinous carcinoma, clear cell adenocarcinoma of the urinary bladder vs clear cell carcinoma of the pelvic kidney. We had one case of urachal and 5 cases of non-urachal carcinoma.

Conclusions: Primary adenocarcinoma of the urinary bladder is an unusual tumor accounting for 0.5 to 2% of all bladder malignancies. They are commonly seen in endemic areas like schistosomiasis. By origin they are grouped into urachal and non-urachal carcinoma and histologically grouped as enteric, mucinous, clear cell and adenocarcinoma not otherwise specified. Direct consultation with the urologist, clinical findings, investigations and careful screening of histological material will help the pathologist to arrive at a correct diagnosis.