Urothelial carcinoma with villoglandular differentiation

Abstract

The patient is a 72-year-old man who presented with hematuria. On cystoscopy, a large friable mass was identified involving the left bladder wall. A transurethral resection of the bladder tumor was performed. Histologically, the tumor was composed of superficial finger-like processes lined by epithelium with true glandular lumina with intraluminal mucin, intimately admixed with invasive high grade urothelial carcinoma. Several glands also had cribriform features and some were lined by non-mucin producing cuboidal to columnar cells. Variable amounts of intraluminal necrosis, apoptotic bodies, and eosinophilic secretions were also present. The tumor invaded the muscularis propria (Detrusor muscle). A diagnosis of urothelial carcinoma with villoglandular differentiation with made. Urothelial carcinoma with villoglandular differentiation is a relatively recently described aggressive variant of urothelial carcinoma. Mean patient age at presentation is 70 years (range: 4684 years) with a male predominance (5:1). Other aggressive variants of urothelial carcinoma have also been associated with this tumor including, micropapillary urothelial carcinoma, plasmacytoid urothelial carcinoma, sarcomatoid urothelial carcinoma and small cell carcinoma. Tumors that may mimic urothelial carcinoma with villoglandular differentiation include colorectal adenocarcinoma, prostatic ductal adenocarcinoma, urachal carcinoma, villous adenoma and other entities.