Glandular lesions of the urinary bladder:clinical significance and differential diagnosis

Abstract

A variety of glandular or pseudoglandular lesions may be seen in the urinary bladder, ranging from those that are entirely benign to aggressive-behaving malignant primary and secondary tumours. Lesions with minimal to no evident premalignant potential include several proliferative and reactive processes, such as cystitis cystica and cystitis glandularis, although the possibility exists for confusion of such lesions with an infiltrative neoplasm, particularly in limited biopsy specimens. Similarly, ectopic tissues of Müllerian origin may be seen occasionally in the urinary bladder and their differentiation from a true glandular neoplasm is important to avoid improper treatment. As urothelial carcinoma has a propensity for divergent differentiation, a wide spectrum of morphological variants exists with varying degrees of glandular differentiation. Some such variants have demonstrated clinical behaviour that is more aggressive than their histology would suggest, thus deserving recognition and potentially different treatment. In this paper, we review the glandular lesions of the urinary bladder ranging from benign proliferative processes to malignant primary and secondary neoplasms, with emphasis on clinical significance and features useful in resolving their differential diagnoses.

Distinguishing primary adenocarcinoma of the urinary bladder from secondary involvement by colorectal adenocarcinoma: extended immunohistochemical profiles emphasizing novel markers

“…1,[4][5][6] Therefore, distinguishing them from the secondary involvement of the urinary bladder by adenocarcinoma of another organ, especially the colon, is often challenging or impossible by light microscopy alone. 6 Although immunohistochemical markers such as CK7, CK20, villin, CDX-2, and b-catenin have been proposed to aid in resolving the differential diagnosis of these tumors, limitations in sensitivity and specificity have prevented any single marker or small panel of markers from emerging as clearly superior. [6][7][8][9][10] Differential diagnostic challenges remain and the identification of additional diagnostic tools is necessary.…”

“…6 Although immunohistochemical markers such as CK7, CK20, villin, CDX-2, and b-catenin have been proposed to aid in resolving the differential diagnosis of these tumors, limitations in sensitivity and specificity have prevented any single marker or small panel of markers from emerging as clearly superior. [6][7][8][9][10] Differential diagnostic challenges remain and the identification of additional diagnostic tools is necessary. Cadherin-17 (CDH17), also called liver-intestinal cadherin or human peptide transporter-1, has been recently recognized as a sensitive and specific marker for adenocarcinoma of the digestive system, especially colorectal adenocarcinoma.…”

EGFR alterations and EML4-ALK rearrangement in primary adenocarcinoma of the urinary bladder

“…3,6,12,15,22,23,[30][31][32][33] In both the lung and the colon, some authors have reported a correlation with the presence of increased EGFR copy number and response to EGFR tyrosine kinase inhibitors and anti-EGFR monoclonal antibodies, respectively. Others have found conflicting results and, therefore, current recommendations for lung adenocarcinoma favor mutational testing over EGFR polysomy.…”

“…[1][2][3] In some cases, primary adenocarcinoma has been associated with bladder exstrophy. [4][5][6] Patients with primary urinary bladder adenocarcinoma tend to present at a higher stage than those with urothelial carcinoma, although in some circumstances survival appears similar to or better than that of urothelial carcinoma. 6,7 Histologically, tumors tend to demonstrate enteric morphology, closely resembling colonic adenocarcinoma.…”

“…[4][5][6] Patients with primary urinary bladder adenocarcinoma tend to present at a higher stage than those with urothelial carcinoma, although in some circumstances survival appears similar to or better than that of urothelial carcinoma. 6,7 Histologically, tumors tend to demonstrate enteric morphology, closely resembling colonic adenocarcinoma. Therefore, care must be taken to exclude the possibility of secondary involvement of the urinary bladder in a primary colorectal tumor.…”