Clear Cell Adenocarcinoma Research Articles

A case of bevacizumab has responded to platinum-resistance of young ovarian clear cell adenocarcinoma

A case of bevacizumab has responded to platinum-resistance of young ovarian clear cell adenocarcinoma

Clear cell adenocarcinoma of uterine cervix in a 19-year-old virgin unrelated to diethylstilbestrol exposure

Clear-cell carcinoma of cervix (CCC) is rarely seen in clinical practice nowadays, especially post the diethylstilbestrol (DES) era. Its association is well established with DES exposure in the adolescent age group. We report a rare case of CCC in a 19-year-old Asian female with no history of exposure to DES. She underwent radical hysterectomy with unilateral salpingoopherectomy and was kept on follow-up and had shown no signs of recurrence even after 1 year of follow-up. Relevant literature is reviewed including possible etiology, appropriate treatment, and prognostic factors.

Diethylstilbestrol 暴露歴のない腟原発明細胞腺癌の 1 例

Diethylstilbestrol 暴露歴のない腟原発明細胞腺癌の 1 例

Retroperitoneal sarcoma: A single institute experience with literature review

s / Urological Science 26 (2015) 294e300 295 (p< 0.02) which was poor performance in facets of overall QoL(0.046), enjoying of life(p1⁄4 0.001), meaning of life(p1⁄4 0.01), time for leisure activity(p1⁄4 0.002). However, log of PSA showed lack of impact in QoL. Conclusion: Our data demonstrated the PSA values and trend of PSA value play an important role in determining QoL in Taiwanese PC patients. Which could provide information for clinician in decision making. The underlying reason is worth to explore in future. MP1-4: PRIMARY CLEAR CELL ADENOCARCINOMA DERIVED FROM ENDOMETRIOSIS OF URINARY BLADDER Chin-Wei Kuo, Jen-Sen Lin, Meng-Yi Yan, Heng-Chieh Chiang. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua,

Nephrogenic adenoma at urinary bladder

s / Urological Science 26 (2015) 294e300 295 (p< 0.02) which was poor performance in facets of overall QoL(0.046), enjoying of life(p1⁄4 0.001), meaning of life(p1⁄4 0.01), time for leisure activity(p1⁄4 0.002). However, log of PSA showed lack of impact in QoL. Conclusion: Our data demonstrated the PSA values and trend of PSA value play an important role in determining QoL in Taiwanese PC patients. Which could provide information for clinician in decision making. The underlying reason is worth to explore in future. MP1-4: PRIMARY CLEAR CELL ADENOCARCINOMA DERIVED FROM ENDOMETRIOSIS OF URINARY BLADDER Chin-Wei Kuo, Jen-Sen Lin, Meng-Yi Yan, Heng-Chieh Chiang. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua,

Primary clear cell adenocarcinoma derived from endometriosis of urinary bladder

s / Urological Science 26 (2015) 294e300 295 (p< 0.02) which was poor performance in facets of overall QoL(0.046), enjoying of life(p1⁄4 0.001), meaning of life(p1⁄4 0.01), time for leisure activity(p1⁄4 0.002). However, log of PSA showed lack of impact in QoL. Conclusion: Our data demonstrated the PSA values and trend of PSA value play an important role in determining QoL in Taiwanese PC patients. Which could provide information for clinician in decision making. The underlying reason is worth to explore in future. MP1-4: PRIMARY CLEAR CELL ADENOCARCINOMA DERIVED FROM ENDOMETRIOSIS OF URINARY BLADDER Chin-Wei Kuo, Jen-Sen Lin, Meng-Yi Yan, Heng-Chieh Chiang. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua,

ARID1A gene mutation in ovarian and endometrial cancers (Review).

The AT-rich interacting domain-containing protein 1A gene (ARID1A) encodes ARID1A, a member of the SWI/SNF chromatin remodeling complex. Mutation of ARID1A induces changes in expression of multiple genes (CDKN1A, SMAD3, MLH1 and PIK3IP1) via chromatin remodeling dysfunction, contributes to carcinogenesis, and has been shown to cause transformation of cells in association with the PI3K/AKT pathway. Information on ARID1A has emerged from comprehensive genome-wide analyses with next-generation sequencers. ARID1A mutations have been found in various types of cancer and occur at high frequency in endometriosis-associated ovarian cancer, including clear cell adenocarcinoma and endometrioid adenocarcinoma, and also occur at endometrial cancer especially in endometrioid adenocarcinoma. It has also been suggested that ARID1A mutation occurs at the early stage of canceration from endometriosis to endometriosis-associated carcinoma in ovarian cancer and also from atypical endo-metrial hyperplasia to endometrioid adenocarcinoma in endometrial cancer. Therefore, development of a screening method that can detect mutations of ARID1A and activation of the PI3K/AKT pathway might enable early diagnosis of endometriosis-associated ovarian cancers and endometrial cancers. Important results may also emerge from a current clinical trial examining a multidrug regimen of temsirolimus, a small molecule inhibitor of the PI3K/AKT pathway, for treatment of advanced ovarian clear cell adenocarcinoma with ARID1A mutation and PI3K/AKT pathway activation. Also administration of sorafenib, a multikinase inhibitor, can inhibit cancer proliferation with PIK3CA mutation and resistance to mTOR inhibitors and GSK126, a molecular-targeted drug can inhibit proliferation of ARID1A-mutated ovarian clear cell adenocarcinoma cells by targeting and inhibiting EZH2. Further studies are needed to determine the mechanism of chromatin remodeling dysregulation initiated by ARID1A mutation, to develop methods for early diagnosis, to investigate new cancer therapy targeting ARID1A, and to examine the involvement of ARID1A mutations in development, survival and progression of cancer cells.

Low Expression of S100P Is Associated With Poor Prognosis in Patients With Clear Cell Adenocarcinoma of the Ovary.

The S100P protein stimulates cell proliferation and survival, thereby contributing to cancer progression. The purposes of this study were to evaluate S100P expression in ovarian clear cell adenocarcinoma and to determine whether S100P expression was correlated with the clinicopathological features or prognoses of patients with clear cell adenocarcinoma. We examined S100P expression in 30 ovarian clear cell adenocarcinoma specimens using immunohistochemistry analysis. The Kaplan-Meier method was used for analysis of overall survival, and comparisons were made based on the log-rank test. Negative staining for nuclear S100P was associated with a poor prognosis as compared with that of positive staining for nuclear S100P in specimens from patients with clear cell adenocarcinoma. These data suggested that S100P may serve as an independent prognostic factor and marker for acquired resistance to chemotherapeutic drugs in clear cell adenocarcinoma.

Clear Cell Adenocarcinoma Arising from Adenofibroma in a Patient with Endometriosis of the Ovary.

Ovarian clear cell adenocarcinomas (CCACs) are frequently associated with endometriosis and, less often with clear cell adenofibromas (CCAFs). We encountered a case of ovarian CCAC arising from benign and borderline adenofibromas of the clear cell and endometrioid types with endometriosis in a 53-year-old woman. Regions of the adenofibromas showed transformation to CCAC and regions of the endometriosis showed atypical endometriotic cysts. This case demonstrates that CCAC can arise from CCAF or endometriosis.

Colon Metastasis From Gastric Adenocarcinoma

The colon is a common site of primary malignancy; however it is very rare metastatic localization. Here we describe a case of a signet ring cell carcinoma of the stomach metastasizing to the cecum and terminal ilium. Although colonoscopy finding was not very impressive, histopathology uncovers the diagnosis of clear cell adenocarcinoma of the colon and small intestine. 59 years- old male with history of Coronary artery disease who underwent percutaneous coronary intervention with stents in 2012. Few months later he developed hematemesis. EGD was performed which shows gastric ulcer. Biopsy revealed poorly differentiated clear cell adenocarcinoma Her 2 positive. Work up for metastasis was negative. It was staged as IIB. He underwent partial gastrectomy with Roux- en-Y Procedure. Subsequently, he received neo-adjuvant chemotherapy. Patient was then followed up with imaging and subsequent EGDs with no evidence of disease recurrence. In 2014 patient presented with melena. His CEA was elevated. Repeated EGD shows no evidence of recurrence. He also started to develop Melena. Colonoscopy was performed in Feb 2015 revealing hyper vascular area. Biopsy from the lesion showed poorly differentiated signet cell adenocarcima with similar histopathology and grading of previous gastric cancer. It was concluded that the malignancy is likely metastatic from gastric cancer. Patient underwent exploratory laparotomy with Right hemi colectomy. Two lesions were also noted in the terminal ilium that were resected. Histopathology confirms the diagnosis of signet cell adenocarcinoma in colon and small intestine. Patient underwent imaging for further staging which shown no evidence of other metastasis. He was then started on chemotherapy including Taxol and Herceptin. Metastases rarely involve the intestinal tract. As a matter of fact, gut metastases have been mostly described for specific tumors such as melanoma and contiguous Spreading of ovarian carcinoma. Gastric cancer spread to the colon is very rare, when it occur it carries a very poor prognosis and denotes likely poorly differentiated and aggressive type of cancer. Generally this unusual localization has been associated to Lauren's diffuse type histology and peritoneal dissemination. In our patient gross colonoscopy finding was not impressive, however pathology revealed the diagnosis. Clinicians should be aware that because of infiltrative nature of the disease, grossly it can appear as only mucosal color changes and only lesion biopsy can reveal the diagnosis of such rare, though aggressive metastasis. Nonetheless, gastric adenocarcinoma, especially if it is poorly differentiated or the signet ring cell type, should be considered as one of the common tumors that have the propensity for rare intestinal metastases.

Cancer of the corpus uteri.

Cancer of the corpus uteri.

Abstract 3385: Cancerous tissue can be identified by the presence of oxMIF, the oxidized form of macrophage migration inhibitory factor

Abstract Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine and is pathologically associated with several types of cancer. We identified oxMIF, an immunological and conformationally distinct isoform of MIF that can be mimicked in vitro by mild oxidation of recombinant MIF. Fully human monoclonal antibodies that specifically target oxMIF were shown to inhibit signaling pathways associated with tumor proliferation and progression in vitro and in vivo in syngeneic or xenogeneic animal models. To evaluate the use of oxMIF as a biomarker of malignant tissue, we acquired plasma and tumor tissues from patients with colorectal cancer (CRC), ovarian, and non-small cell lung cancer (NSCLC), as well as control plasma and control tissue from healthy donors, i.e. in a normal state of health, with no apparent signs of disease. We developed a novel immunohistochemistry (IHC) method to detect oxMIF in malignant tissues and used a specific new ELISA to detect oxMIF in plasma. In patients with CRC, we detected oxMIF by IHC in primary tumors (31 of 39) and in liver, lung and lymph-node metastases (n = 10). Staining intensities showed variation between different tumor cells, as well as in the microenvironment. Similarly, we detected oxMIF by IHC in most types of ovarian cancer (n = 42), but not in controls (n = 4), and observed some variations in the localization and intensities of staining. We also detected oxMIF in liver metastases from patients with ovarian cancer (n = 2). In patients with NSCLC (n = 32), 22 samples showed a strong staining for oxMIF. In tissues from healthy donors (4 colon, 4 ovary and 3 lung), oxMIF was not or barely detectable, whereas total MIF (sum of reduced and oxidized MIF) was widely expressed in normal and tumor tissues and showed a more diffuse spatial distribution than oxMIF. In commercially acquired plasma samples from patients with CRC (n = 46) and NSCLC (n = 15), we did not observe a significant increase of oxMIF levels (median = 0 for both) compared with the plasma from healthy donors (median = 0; n = 69). In patients with ovarian cancer, significant increased levels of oxMIF were measured in plasma (median = 3.5ng/mL, n = 42), and more specifically from patients with papillary serous cystadenocarcinoma or serous cystadenocarcinoma compared with clear cell adenocarcinoma (medians = 3.5, 4.0, and 0 ng/mL respectively). Our studies demonstrated that oxMIF is a disease-related isoform of MIF that can be specifically detected in tissues from various types of cancer. We therefore suggest that oxMIF reflects a new biomarker in solid tumors and has potential diagnostic and prognostic value. A phase 1 clinical study of a novel human antibody that selectively targets oxMIF is currently ongoing in patients with solid malignancies (ClinicalTrials.gov identifier: NCT01765790). Citation Format: Nicolas Sabarth, Dirk Völkel, Michael Thiele, Alexander Schinagl, Patrice Douillard, Friedrich Scheiflinger, Randolf Kerschbaumer. Cancerous tissue can be identified by the presence of oxMIF, the oxidized form of macrophage migration inhibitory factor. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3385. doi:10.1158/1538-7445.AM2015-3385

Optimal cytoreductive surgery for underlying ovarian cancer associated with deep venous thrombosis without placement of inferior vena cava filter: A case report and literature review.

Ovarian cancer associated with deep venous thrombosis (DVT) is an uncommon, potentially life-threatening condition. The primary therapeutic strategy for the treatment of this condition is up-front primary cytoreductive surgery, with placement of an inferior vena cava (IVC) filter prior to surgery to prevent fatal pulmonary embolism. The present study describes the case of a 49-year-old female, who presented with DVT unresponsive to anticoagulant therapy in the lower extremities prior to the diagnosis of ovarian cancer. During the search for the underlying malignancy, transvaginal sonography (TVS) revealed a cystic solid mass in the pelvic cavity. Subsequently, the patient underwent up-front primary cytoreductive surgery without placement of a preoperative IVC filter, followed by six cycles of chemotherapy. The patient was diagnosed with ovarian clear cell adenocarcinoma stage IIIC, complicated by DVT, and had survived >3 years without relapse at the time of completion of the present study. The successful outcome of the present case demonstrated that occult primary cancer should be suspected in patients with DVT unresponsive to anticoagulant therapy. The present study also indicated that up-front primary cytoreductive surgery without placement of an IVC filter represents an effective potential strategy for the treatment of advanced ovarian cancer associated with DVT, as the thrombus strongly adheres to the vessel wall following organization.

Musashi-1 Expression is a Prognostic Factor in Ovarian Adenocarcinoma and Correlates with ALDH-1 Expression.

The presence of cancer stem-like cells (CSCs) has been demonstrated to be associated with tumor metastasis, chemoresistance, and rapid recurrence of various tumors. The impact of CSC-related markers in the metastasis and prognosis of ovarian cancer has not been well established. In this study, the protein expression of musashi-1 and ALDH1 was measured using immunohistochemistry. Results demonstrated that the percentage of positive musashi-1 and ALDH1 expression were significantly higher in ovarian serous adenocarcinomas, mucinous adenocarcinomas and clear cell adenocarcinomas than in cystadenomas and normal tissues. The percentage of positive musashi-1 and ALDH1 expression were significantly lower in patients identified with clinical stage I or II ovarian adenocarcinomas without lymph node metastasis compared to patients with clinical stage III or IV tumors and lymph node metastasis. The expression of musashi-1 and ALDH1 was found to be highly consistent in ovarian adenocarcinomas. Univariate Kaplan-Meier analysis showed a negative correlation between musashi-1 or ALDH1 expression and overall survival. Multivariate Cox regression analysis showed that positive expression of musashi-1 or ALDH1 in ovarian adenocarcinoma was an independent predictor of poor prognosis. Our study suggested that musashi-1 and ALDH1 expression are closely related to metastasis of ovarian adenocarcinoma. The positive expression of musashi-1 and ALDH1 might be a poor-prognostic factor of ovarian adenocarcinoma.

Poor Outcomes After Conservative Management for Low-Grade, Apparent Early-Stage Endometrial Cancer [334

INTRODUCTION: The conservative (fertility preserving) management of low-grade, early-stage endometrial cancer is gaining popularity. Some concerns could be raised in view of the tendency to underreport poor outcomes such as death, progression to advanced stage, or higher grade disease. METHODS: We reviewed published poor outcomes of low-grade, early-stage endometrial cancer and present two women who desired conservative management for fertility-preserving purposes and sustained poor outcomes in one tertiary care facility over a 5-year period. RESULTS: Despite established conservative management, the first patient's low-grade, early-stage endometrial cancer concealed an underlying pathology of clear cell adenocarcinoma. In the second case, a patient with low-grade endometrial cancer refused hysterectomy to attain fertility and when she accepted, was found to have stage IIIC1 (International Federation of Gynecology and Obstetrics 2009) disease. IMPLICATION: These cases indicate that conservative management of endometrial cancer should still be considered with caution, performed by experienced teams, and the potential risks be explained to the patients.

The clinical characteristics and outcomes of cases with pure ovarian clear cell, mixed type and high-grade serous adenocarcinoma.

This study aimed to compare the clinical characteristics and outcomes of the cases with pure ovarian clear cell adenocarcinoma (OCCC), mixed type (clear plus serous or clear plus endometrioid or serous plus clear plus endometrioid) ovarian adenocarcinoma (MOC) and high-grade serous ovarian adenocarcinoma (HGSOC). A retrospective comparison was conducted in 32 cases with pure OCCC, 23 cases with MOC and 28 cases with HGSOC followed between January 1999 and October 2011. Clinico-pathologic characteristics including histopathologic subtypes, age, stage, presence of ascites and/or peritoneal carcinomatosis, endometriosis and optimal cytoreduction, and also survival rates were compared in these three groups. The cases with pure OCCC were younger than the cases with MOC and HGSOC (p=0.004). The median pre-operative CA-125 level was lower in the pure OCCC than in MOC and HGSOC (p=0.006) (p=0.001, p=<0.001, respectively). Bilaterality and peritoneal carcinomatosis were more frequently seen in the HGSOC group (p=0.001, p<0.001, respectively). The majority of the cases (65%) had stage I or II disease in the pure OCCC group, but most of the cases in the HGSOC group had advanced stage disease (p<0.001). Endometriosis was found in 16 cases (16/55, 29%) in the OCCC group. No significant difference was detected with regard to the median survival rate among three groups (p=0.517), while the stage of disease was found to be the only important factor for survival (p=0.002). Pure OCCC, MOC and HGSOC represent distinct clinical characteristics. Clinical characteristics of MOC are more similar to those of HGSOC.

Factors associated with a lack of pap smear utilization in women exposed in utero to diethylstilbestrol.

Women in the 1940s-1960s were prescribed diethylstilbestrol (DES), a nonsteroidal estrogen, to prevent miscarriages, but the practice was terminated after it was discovered that the daughters so exposed in utero were at increased risk for developing clear cell adenocarcinoma (CCA) of the vagina or cervix at early ages. Pap smear screening is one of the principal methods used to identify tumor development and is necessary in this group of women to maintain their health. Currently, little is known about the factors associated with nonutilization of this screening tool in this high-risk population of women. National cohort data from the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study during 1994, 1997, 2001, and 2006 were used to determine which factors were associated with Pap smear screening nonutilization in 2006 among DES-exposed and unexposed women. Self-reported questionnaire data from 2,861 DES-exposed and 1,027 unexposed women were analyzed using binary logistic regression models. DES exposure, not having a previous gynecologic dysplasia diagnosis, lack of insurance, originating cohort, increasing age, and previous screening behavior were all factors associated with not reporting a Pap smear examination in the 2006 questionnaire, although college education reduced nonutilization. Understanding which factors are associated with not acquiring a screening exam can help clinicians better identify which DES-exposed women are at risk for nonutilization and possibly tailor their standard of care to aid in the early detection of cervical and vaginal adenocarcinomas in this high-risk group.

MP16-10 EQUITABLE COMMUNITY UTILIZATION OF PARTIAL NEPHRECTOMY NATIONALLY FOR MANAGEMENT OF T1A RENAL TUMORS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-10 EQUITABLE COMMUNITY UTILIZATION OF PARTIAL NEPHRECTOMY NATIONALLY FOR MANAGEMENT OF T1A RENAL TUMORS Dhruti Patel and Robert Abouassaly Dhruti PatelDhruti Patel More articles by this author and Robert AbouassalyRobert Abouassaly More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.817AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous outcomes research based on the NIS and SEER data has indicated continued underuse of partial nephrectomy as a management strategy for T1a renal masses. Part of this was attributed to the poor diffusion into the community, which we sought to further analyze with the National Cancer Database. METHODS The National Cancer Database captures over seventy percent of newly diagnosed cancer cases in the United States. The national utilization of partial nephrectomy for localized T1a renal masses from 1998 to 2011 was evaluated based on hospital type, either Comprehensive Community Cancer Centers (CCCC) or Academic Cancer Centers (ACC). Only clear cell adenocarcinoma, renal cell carcinoma, papillary adenocarcinoma, chromophobe renal cell carcinoma, sarcomatoid renal cell carcinoma, cystic renal cell carcinoma, and collecting duct renal cell carcinoma were included. Multivariate linear regression and chi-square analyses were performed to evaluate the differences between variables. RESULTS 240,309 cases were identified from 1998 to 2011 with 52% undergoing partial nephrectomy. At both hospital types, utilization of partial nephrectomy annually for T1a renal cancers has statistically significantly (p<0.0001) increased to become the treatment of over half (53%) of all newly diagnosed cases. Based on a multivariate logistic regression, there are a number of factors that affect the utilization of partial nephrectomy. Younger age, white race, private insurance, male gender, hospital type and year all affect the likelihood of partial nephrectomy utilization for T1a tumors. The c statistic for the multivariate linear regression was 0.75. The likelihood of partial nephrectomy is still higher at ACC compared to CCCC (p<0.0001), though a significant number are performed at each hospital type. Both hospital types have similar length of stay, positive surgical margin, 30 day mortality and readmission rates. CONCLUSIONS There has been in a clear shift in the management of T1a renal masses with continued increases in the utilization of partial nephrectomy. This surgical treatment continues to be prevalent in the academic hospital setting and has diffused into the community. This shift may be indicative of the rigorous residency training across the country. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e171 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhruti Patel More articles by this author Robert Abouassaly More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Significance of p53 expression in background endometrium in endometrial carcinoma.

The p53 signature (p53S) has been proposed to be a marker of the earliest phase of development of endometrial serous carcinoma. We examined the presence of p53S in the background endometrium in cases of endometrial carcinoma. From a series of 351 endometrial carcinomas, 225 (64.1 %) lesions, for which slides of the adjacent noncancerous endometrium were available for review, were included. Expression of estrogen receptor (ER)-alpha, Ki-67, and p53 in the adjacent endometrium was studied by immunohistochemistry. The p53S was defined as the presence of morphologically benign endometrial epithelial cells with moderate to strong intensity of p53 immunostaining. Of the 225 noncancerous endometrium samples, 34 consisted of hyperplastic and 191 of non-hyperplastic endometrium. A p53S was found in 22 cases (mean age 64.2 years), 2 in hyperplastic, and 20 in non-hyperplastic background endometrium. All p53S-positive cases also expressed ER-alpha; their median Ki-67 labeling index (LI) was 4.0 % (range 0.0 to 21.0 %). The two cases with hyperplastic p53S-positive background endometrium were in association with a grade 1 endometrioid tumor in a premenopausal woman with Lynch syndrome. Of the 152 cases of endometrioid adenocarcinomas with non-hyperplastic endometrium, 12 (8 %) were p53S positive, none of which associated with EIC. Of the 21 cases of serous carcinoma, five (24 %) were p53S positive, 4 of which (19 %) associated with EIC while in 5 others (24 %) EIC was found without p53S. Of three clear cell adenocarcinomas, none were p53S positive while two contained EIC without p53S. Of 15 carcinosarcomas, 3 (20 %) were p53S positive, all of which with EIC while 6 others (40 %) were associated with EIC but without p53S. Of the 8 non-endometrioid tumors with p53S, 7 (88 %) were associated with EIC. p53S is thought to be associated with precancerous lesions of non-endometrioid tumors, including carcinosarcomas.

Nephrogenic Adenoma of the Urinary Bladder: A Review of the Literature.

Background. Nephrogenic adenoma of the urinary bladder (NAUB) is a rare lesion associated with nonspecific symptoms and could inadvertently be misdiagnosed. Aim. To review the literature. Methods. Various internet search engines were used. Results. NAUB is a benign tubular and papillary lesion of the bladder, is more common in men and adults, and has been associated with chronic inflammation/irritation, previous bladder surgery, diverticula, renal transplantation, and intravesical BCG; recurrences and malignant transformations have been reported. Differential diagnoses include clear cell adenocarcinoma, endocervicosis, papillary urothelial carcinoma, prostatic adenocarcinoma of bladder, and nested variant of urothelial carcinoma; most NAUBs have both surface papillary and submucosal tubular components; both the papillae and tubules tend to be lined by a single layer of mitotically inactive bland cells which have pale to clear cytoplasm. Diagnosis may be established by using immunohistochemistry (positive staining with racemase; PAX2; keratins stain positive with fibromyxoid variant), electron microscopy, DNA analysis, and cytological studies. Treatment. Endoscopic resection is the treatment but recurrences including sporadic malignant transformation have been reported. Conclusions. There is no consensus on best treatment. A multicentre study is required to identify the treatment that would reduce the recurrence rate, taking into consideration that intravesical BCG is associated with NAUB.