Recurrent Superficial Papillary Adenocarcinoma of the Bladder

Abstract

Primary adenocarcinoma of the bladder is the third most common type of bladder carcinoma after transitional and squamous cell carcinomas. This neoplasm comprises 0.5% to 2% of all epithelial malignant bladder tumors. Primary vesical adenocarcinomas are most frequently single lesions with a predilection for the trigone and bladder dome. Most of these lesions are muscle invasive at presentation. Papillary adenocarcinoma, a rare subtype of bladder adenocarcinoma, was first reported in 1985.1 We report a unique case of recurrent superficial papillary adenocarcinoma of the bladder that was managed conservatively without progression for more than 5 years. CASE REPORT A 60-year-old white female presented with moderate persistent irritative bladder symptoms. Medical history was remarkable for grade 1 colon carcinoma that was resected in 1981, breast cancer with lymph node involvement that was treated with modified radical mastectomy, axillary node dissection, chemotherapy and 8 to 9 years of hormonal therapy (tamoxifen); neurofibromatosis of the trunk and limbs; temporal lobe seizures and Hashimoto’s thyroiditis. The patient also had a history of allergic reaction (hives) to certain drugs. She was initially diagnosed with interstitial cystitis. However, cystourethroscopy in November 1995 showed a papillary tumor involving the left anterolateral bladder wall with several small satellite lesions. The tumor was resected and pathological examination demonstrated low grade papillary adenocarcinoma with clear cell features with invasion to the lamina propria but no muscle invasion. Differential diagnosis was supported by positive mucicarmine and CA 125 staining (figs. 1 and 2). Evaluation for metastasis was negative.