Urinary Bladder Adenocarcinoma Metastatic to the Abdominal Wall: Report of a Case with Cytohistologic Correlation.

Vikas Nath,Mithra Baliga

doi:10.1155/2016/8608412

Abstract

We report a case of adenocarcinoma metastatic to the abdominal wall in a 71-year-old man with a history of primary bladder adenocarcinoma. CT-guided core biopsy was performed; imprints and histologic sections showed malignant glands lined by tumor cells with hyperchromatic nuclei and prominent nucleoli, infiltrating through skeletal muscle. Immunohistochemistry revealed positivity for CK7, membranous/cytoplasmic β-catenin, caudal-type homeobox transcription factor 2 (CDX2), and α-methylacyl coenzyme A racemase and negativity for CK20, p63, prostate-specific antigen (PSA), and prostate-specific acid phosphatase (PSAP). These findings were interpreted as metastatic adenocarcinoma, consistent with bladder primary. Primary bladder adenocarcinoma is a rare malignancy arising within glandular metaplasia and is associated with cystitis cystica and cystitis glandularis. Predisposing factors include bladder exstrophy, schistosomiasis, and other causes of chronic bladder irritation. This tumor is divided into intestinal, clear cell, and signet ring cell subtypes. Treatment involves radical cystectomy with pelvic lymph node dissection, and prognosis is unfavorable. Primary bladder adenocarcinoma should be differentiated from urachal adenocarcinoma, which arises from urachal remnants near the bladder dome, and secondary adenocarcinoma, or vesical involvement by adenocarcinoma from a different primary. CK7, CK20, CDX2, thrombomodulin, and β-catenin can help distinguish primary bladder adenocarcinoma from colonic adenocarcinoma; PSA and PSAP can help distinguish primary bladder adenocarcinoma from prostate adenocarcinoma.

Highlights

Primary adenocarcinoma of the urinary bladder is an uncommon malignancy that accounts for 0.5 to 2% of all malignant bladder neoplasms [1,2,3,4,5]; it is the third most common type of bladder carcinoma, after urothelial carcinoma (UC) and squamous cell carcinoma [1, 2]
We report a patient with primary bladder adenocarcinoma who developed a metastasis to the abdominal wall, diagnosed by examination of imprints and histologic sections of a CT-guided core biopsy
The diversity of glandular neoplasms that can occur in the urinary bladder makes the diagnosis of primary bladder adenocarcinoma in cytologic preparations uniquely challenging

Summary

Introduction

Primary adenocarcinoma of the urinary bladder is an uncommon malignancy that accounts for 0.5 to 2% of all malignant bladder neoplasms [1,2,3,4,5]; it is the third most common type of bladder carcinoma, after urothelial carcinoma (UC) and squamous cell carcinoma [1, 2]. Most often, it presents in the sixth decade of life and has a predilection for males [1, 3, 6]. We report a patient with primary bladder adenocarcinoma who developed a metastasis to the abdominal wall, diagnosed by examination of imprints and histologic sections of a CT-guided core biopsy

Case Report

Findings

Discussion

Conclusion