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Amleh A, Mubarak R, Ayesh HJ, Al-Karaja L, Ayyad M, Allan MA, Natsheh M. A Rare Case of Primary Clear Cell Adenocarcinoma of the Urinary Bladder. Cureus 2023; 15:e39575. [PMID: 37378101 PMCID: PMC10292830 DOI: 10.7759/cureus.39575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Adenocarcinoma is a rare form of urinary bladder cancer, comprising only 2% of cases, with various histological patterns and levels of differentiation. Among these, clear cell adenocarcinoma is the least common. Contrary to other subtypes, clear cell adenocarcinoma of the bladder has been shown to have a female predominance, and typically presents at the age of 60 after being incidentally discovered on radiological and urinary studies. However, signs and symptoms such as visible and non-visible hematuria, and signs and symptoms of urinary tract infection refractory to antibiotic treatment could occur and clue into the diagnosis. Although imaging can reveal and characterise the lesion, definitive diagnosis requires cystoscopy with biopsy. The treatment of adenocarcinoma of the bladder often requires surgical resection, with adjuvant chemotherapy being utilized in a subset of patients. We report a 79-year-old patient complaining of gross hematuria. Ultrasound was performed and showed a calcified mass at the dome of the urinary bladder, which was confirmed by computerized tomography of the abdomen and pelvis. Subsequent cystoscopy confirmed the diagnosis of clear-cell adenocarcinoma and the tumor was resected using a trans-urethral approach. Radical cystectomy with regional lymphadenectomy and adjuvant chemotherapy were used as the primary therapeutic modality.
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Affiliation(s)
| | | | | | | | | | | | - Motaz Natsheh
- Pathology, National Pathology Laboratory, Hebron, PSE
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2
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Miao J, Hu J, Wu J, Guo W, Chen J, Li J. Primary clear cell adenocarcinoma of female urinary tract: a case report and literature review. BMC Womens Health 2022; 22:251. [PMID: 35751118 PMCID: PMC9229477 DOI: 10.1186/s12905-022-01835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Primary clear cell adenocarcinoma of the urethra is extremely rare, reported only in single case reports, and its histological origin is not clear. There is no standard treatment for CCAU at present, and surgery is still the main treatment for CCAU without distant metastasis. Case presentation A 67-year-old female complained of gross hematuria with frequent micturition and urgency. No urethral diverticulum was found by cystoscopy or MRI, and the mass grew around the urethra. Urethral and anterior pelvic viscera resection was performed. Clear cell adenocarcinoma was confirmed by immunohistochemistry after the operation, and no recurrence or metastasis was found after one year of follow-up. Conclusion CCAU is very rare, and most cases originate from the urethral diverticulum and some may also originate from tissues around the urethra. For CCAU patients without distant metastasis, the main treatment is still surgery, and radiotherapy and chemotherapy can be performed for patients with distant metastasis. Gene detection may provide guidance for the precise chemotherapy of CCAU.
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Affiliation(s)
- Jianguang Miao
- Department of Urology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China.
| | - Jiebin Hu
- Department of Urology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Jilin Wu
- Department of Urology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Wei Guo
- Department of Urology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Jin Li
- Department of Urology, Xiangtan Central Hospital, Xiangtan, 411100, Hunan, China.
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3
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Urethral clear cell carcinoma - Case report and review of litrature. Urol Case Rep 2021; 38:101659. [PMID: 33868945 PMCID: PMC8047157 DOI: 10.1016/j.eucr.2021.101659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Abstract
Urethral clear cell carcinoma is very rare disease affecting both sexes, however it is mostly described in female urethra. The origin of this cancer is yet to be discovered. We report a 57 years old lady who presented to our clinic with obstructive lower urinary tract symptoms and found to have a urethral diverticulum containing a soft tissue lesion found to be a clear cell carcinoma after excision. Having high suspicion and early detection of these cases leads to a better outcome.
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Padilla-Ansala C, García-Fernández E, González-Peramato P. Histopathological Subtypes and PD-L1 Expression in Primary Urethral Adenocarcinoma: A Series of 5 Cases. Int J Surg Pathol 2021; 29:488-495. [PMID: 33463392 DOI: 10.1177/1066896920988348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Urethral adenocarcinoma is a rare disease with poor prognosis that can display multiple histologic patterns and has an unclear histogenesis. Radical surgery with extensive periurethral resection is the preferred therapeutic approach. Both chemotherapy and radiotherapy have been used as complementary treatment options. Due to the tendency of these tumors to recur, treatment-associated complications, and the limited choice of therapeutic options, patient management can be difficult. Given the lack of literature regarding immunotherapy in urethral adenocarcinoma, our objective was to explore the expression of programmed death receptor-ligand 1 (PD-L1) throughout the different histological subtypes of primary urethral adenocarcinoma. METHODS We reviewed all primary urethral adenocarcinomas diagnosed at our hospital between 1965 and 2019, performed immunohistochemical assays on the tissue blocks, classified them according to their histology and origin, and performed PD-L1 (22C3) immunohistochemistry assays in all cases. RESULTS We found a total of 5 cases of primary urethral adenocarcinoma. All of the patients were women. One of the cases was a cribriform adenocarcinoma, 2 were columnar-mucinous adenocarcinomas, and 2 were clear cell adenocarcinomas. One of the clear cell adenocarcinomas strongly expressed PD-L1. In addition, a profuse inflammatory infiltration constituted by CD3-positive and CD8-positive T lymphocytes within tumor cells was observed in this case. None of the other cases showed PD-L1 expression. CONCLUSIONS In conclusion, some urethral adenocarcinomas may strongly express PD-L1 and thus could potentially allow the use of immunotherapy in selected cases of advanced or recurrent adenocarcinoma.
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Affiliation(s)
- Carlos Padilla-Ansala
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain.,Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Eugenia García-Fernández
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain.,Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pilar González-Peramato
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain.,Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain
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Chan EOT, Chan VWS, Poon JYT, Chan BHK, Yu CP, Chiu PKF, Ng CF, Teoh JYC. Clear cell carcinoma of the urinary bladder: a systematic review. Int Urol Nephrol 2021; 53:815-824. [PMID: 33462714 DOI: 10.1007/s11255-020-02725-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We conducted a systematic review of the literature on primary clear cell carcinoma (CCC) of the urinary bladder. METHODS A literature search using keywords and MeSH terms related to "clear cell carcinoma", "clear cell adenocarcinoma", "mesonephroma" and "urinary bladder" in EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials was performed. A manual search was performed with web-based search engine Google Scholar. Reference lists of the included studies were screened for additional articles. Articles up till 16th July 2020 were retrieved. Observational human studies on primary CCC in urinary bladder with English full-text were included for further analysis. RESULTS 904 articles were identified and 44 articles were included for further analysis. Data including clinical features, tumour characteristics, treatment and oncological outcomes were reviewed. There were 70 patients (44 females and 26 males) reported in literatures and included in this review. Gross haematuria was the most common presentation (79.7%), followed by irritative urinary symptoms (47.5%). Regarding the histology, tubulocystic pattern is the most common histologic pattern (49.1%), and 52.6% had muscle invasion. Most cases were CK7 (96.6%) and CK20 (88.9%) positive. CA125 (96%) was commonly positive, indicating its potential origin from mullerian duct. Most patients received surgery (95.5%) as primary treatment. However, the oncological outcomes were unsatisfactory with a 2-year survival rate of 60.0%. CONCLUSION Clear cell carcinoma is an uncommon subtype of bladder cancer which can be diagnosed by histology and immunohistochemical staining result. The majority of patients presented with muscle invasion and had a poor survival despite aggressive treatment.
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Affiliation(s)
- Erica On-Ting Chan
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Jade Yin-To Poon
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Brian Hang-Kin Chan
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun-Pong Yu
- Li Ping Medical Library, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Kerr L, Salmond J, Ahmad I. Clear cell adenocarcinoma of the urethra presenting with urinary retention: A case report. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415818800539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lynne Kerr
- Department of Urology, Queen Elizabeth University Hospital, UK
| | - Jonathan Salmond
- Department of Pathology, Queen Elizabeth University Hospital, UK
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, UK
- Urology Group, The Beatson Institute for Cancer Research, UK
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7
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Zhou Z, Kinslow CJ, Wang P, Huang B, Cheng SK, Deutsch I, Gentry MS, Sun RC. Clear Cell Adenocarcinoma of the Urinary Bladder Is a Glycogen-Rich Tumor with Poorer Prognosis. J Clin Med 2020; 9:E138. [PMID: 31947882 PMCID: PMC7019566 DOI: 10.3390/jcm9010138] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/29/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022] Open
Abstract
Clear cell adenocarcinoma (CCA) is a rare variant of urinary bladder carcinoma with a glycogen-rich phenotype and unknown prognosis. Using the National Cancer Institute's surveillance, epidemiology, and end results (SEER) program database, we documented recent trends in incidence, mortality, demographical characteristics, and survival on this rare subtype of urinary bladder cancer. The overall age-adjusted incidence and mortality of CCA was 0.087 (95% confidence interval (CI): 0.069-0.107) and 0.064 (95% CI: 0.049-0.081) respectively per million population. In comparison to non-CCAs, CCAs were more commonly associated with younger age (<60 years old, p = 0.005), female (p < 0.001), black ethnicity (p = 0.001), grade III (p < 0.001), and higher AJCC 6th staging (p < 0.001). In addition, CCA patients more frequently received complete cystectomy (p < 0.001) and beam radiation (p < 0.001) than non-CCA patients. Our study showed a poorer prognosis of CCAs compared to all other carcinomas of the urinary bladder (p < 0.001), accounted for by higher tumor staging of CCA cases. This study adds to the growing evidence that glycogen-rich cancers may have unique characteristics affecting tumor aggressiveness and patient prognosis. Additional mechanistic studies are needed to assess whether it's the excess glycogen that contributes to the higher stage at diagnosis.
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Affiliation(s)
- Zhengqiu Zhou
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536, USA; (Z.Z.); (M.S.G.)
| | - Connor J. Kinslow
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA; (C.J.K.); (S.K.C.); (I.D.)
| | - Peng Wang
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA;
| | - Bin Huang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY 40536, USA;
| | - Simon K. Cheng
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA; (C.J.K.); (S.K.C.); (I.D.)
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Israel Deutsch
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA; (C.J.K.); (S.K.C.); (I.D.)
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Matthew S. Gentry
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY 40536, USA; (Z.Z.); (M.S.G.)
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Ramon C. Sun
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Neuroscience, University of Kentucky College of Medicine, Lexington, KY 40536, USA
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Shanks JH, Srigley JR, Brimo F, Comperat E, Delahunt B, Koch M, Lopez‐Beltran A, Reuter VE, Samaratunga H, Tsuzuki T, Kwast T, Varma M, Grignon D. Dataset for reporting of carcinoma of the urethra (in urethrectomy specimens): recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2019; 75:453-467. [DOI: 10.1111/his.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jonathan H Shanks
- Department of Histopathology The Christie NHS Foundation Trust Manchester UK
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto ON Canada
| | - Fadi Brimo
- McGill University Health Center Montréal QC Canada
| | - Eva Comperat
- Department of Pathology Hospital Tenon, HUEP, Sorbonne University Paris France
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences University of Otago Wellington New Zealand
| | - Michael Koch
- Department of Urology Indiana University School of Medicine Indianapolis IN USA
| | | | - Victor E Reuter
- Department of Pathology Memorial Sloan Kettering Cancer Center New York NY USA
| | - Hemamali Samaratunga
- Aquesta Specialized Uropathology Brisbane Qld, Australia
- Centre for Clinical Research The University of Queensland Brisbane Qld, Australia
- Princess Alexandra Hospital Brisbane Qld Australia
| | | | - Theo Kwast
- Laboratory Medicine Program University Health Network, University of Toronto Toronto ON Canada
| | - Murali Varma
- Department of Cellular Pathology University Hospital of Wales Cardiff UK
| | - David Grignon
- IUH Pathology Laboratory, Department of Pathology and Laboratory Medicine Indiana University School of Medicine Indianapolis IN USA
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Jayawardhana T, Alsayed H, Goel A, Madaan S. Non-muscle-invasive clear cell carcinoma of the urinary bladder: Is cystectomy necessary? BMJ Case Rep 2019; 12:e226928. [PMID: 30850563 PMCID: PMC6424185 DOI: 10.1136/bcr-2018-226928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2019] [Indexed: 11/03/2022] Open
Abstract
We report the clinical presentation, histological findings and management of a 49-year-old female patient with non-muscle-invasive clear cell carcinoma of the urinary bladder. In the literature, there are only seven such case reports. We feel that transurethral resection of the bladder tumour followed by close cystoscopy surveillance is a suitable management for non-muscle-invasive clear cell carcinoma of the urinary bladder.
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Affiliation(s)
| | - Hossam Alsayed
- Department of Urology & Nephrology, Darent Valley Hospital, Dartford, UK
| | - Amit Goel
- Department of Histopathology, Maidstone Hospital, Maidstone, UK
| | - Sanjeev Madaan
- Department of Urology & Nephrology, Darent Valley Hospital, Dartford, UK
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10
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Ayari Y, Kerkeni W, Znaidi N, Blel A, Bouzouita A, Ayed H, Cherif M, Ben Slama MR, Derouiche A, Rammeh S, Chebil M. Clear Cell Adenocarcinoma of the Female Urethra, Mimicking Cystocele. Urol Case Rep 2017; 12:26-27. [PMID: 28280687 PMCID: PMC5342984 DOI: 10.1016/j.eucr.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022] Open
Abstract
Clear cell adenocarcinoma of the urethra is an extremely rare neoplasm mainly described in women. Anterior pelvic exenteration was the treatment performed in most reported cases. It seems to have poorer prognosis than urothelial carcinomas.
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Affiliation(s)
- Yassine Ayari
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - Walid Kerkeni
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - Nadia Znaidi
- Department of Anatomopathology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - A Blel
- Department of Anatomopathology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - A Bouzouita
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - H Ayed
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - Mohamed Cherif
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | | | - Amine Derouiche
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Anatomopathology, Charles Nicolle University Hospital of Tunis, Tunisia
| | - Mohamed Chebil
- Department of Urology, Charles Nicolle University Hospital of Tunis, Tunisia
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11
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Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours. Eur Urol 2016; 70:106-119. [PMID: 26996659 DOI: 10.1016/j.eururo.2016.02.028] [Citation(s) in RCA: 1073] [Impact Index Per Article: 134.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/04/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraepithelial neoplasia. New acinar adenocarcinoma variants are microcystic adenocarcinoma and pleomorphic giant cell adenocarcinoma. Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7. The new WHO classification further recommends the recently developed prostate cancer grade grouping with five grade groups. For bladder cancer, the 2016 WHO classification continues to recommend the 1997 International Society of Urological Pathology grading classification. Newly described or better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential, which is frequently identified in patients with a prior history of urothelial carcinoma. Invasive urothelial carcinoma with divergent differentiation refers to tumours with some percentage of "usual type" urothelial carcinoma combined with other morphologies. Pathologists should mention the percentage of divergent histologies in the pathology report. PATIENT SUMMARY Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 World Health Organization classification. Better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential.
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Affiliation(s)
- Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Holger Moch
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Thomas M Ulbright
- Department of Pathology and Laboratory Medicine, Indiana University Health Partners, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Clear cell adenocarcinoma of the urethra: review of the literature. Int J Surg Oncol 2015; 2015:790235. [PMID: 25685552 PMCID: PMC4320870 DOI: 10.1155/2015/790235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/24/2014] [Accepted: 11/25/2014] [Indexed: 02/03/2023] Open
Abstract
Background. Clear cell adenocarcinoma of the urethra (CCAU) is extremely rare and a number of clinicians may be unfamiliar with its diagnosis and biological behaviour. Aims. To review the literature on CCAU. Methods. Various internet databases were used. Results/Literature Review. (i) CCAU occurs in adults and in women in the great majority of cases. (ii) It has a particular association with urethral diverticulum, which has been present in 56% of the patients; is indistinguishable from clear cell adenocarcinoma of the female genital tract but is not associated with endometriosis; and probably does not arise by malignant transformation of nephrogenic adenoma. (iii) It is usually, readily distinguished from nephrogenic adenoma because of greater cytological a-typicality and mitotic activity and does not stain for prostate-specific antigen or prostatic acid phosphatase. (iv) It has been treated by anterior exenteration in women and cystoprostatectomy in men and at times by radiotherapy; chemotherapy has rarely been given. (v) CCAU is aggressive with low 5-year survival rates. (vi) There is no consensus opinion of treatment options that would improve the prognosis. Conclusions. Few cases of CCAU have been reported. Urologists, gynaecologists, pathologists, and oncologists should report cases of CCAU they encounter and enter them into a multicentric trial to determine the best treatment options that would improve the prognosis.
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14
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Wang W, Li X, Qu G, Leng T, Geng J. Primary clear cell adenocarcinoma of the colon presenting as a huge extracolic mass: A case report. Oncol Lett 2014; 8:1873-1875. [PMID: 25202428 PMCID: PMC4156264 DOI: 10.3892/ol.2014.2420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/01/2014] [Indexed: 11/18/2022] Open
Abstract
A primary clear cell adenocarcinoma of the colon is a rare oncologic entity. The current study presents a case of such a tumor in the transverse colon of a 26-year-old male, and describes the computed tomography features of the neoplasm. The tumor appeared as an extensive extracolic mass, which displaced the loop of the small bowel and pancreas, and invaded the spleen. A laparotomy was performed and a huge mass measuring 12 cm maximally was revealed, arising from the transverse colon close to the left colonic flexure, with invasion of the spleen. The tumor and the spleen were resected concurrently. Histopathological examination of the excised mass revealed features of clear cell adenocarcinoma. A primary clear cell adenocarcinoma of the colon is a rare tumor, with only 13 cases reported in the English literature at present. The present case is reported here due to its rarity.
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Affiliation(s)
- Weiwei Wang
- Image Center, Yantai Yuhuangding Hospital, Yantai, Shangdong 264000, P.R. China
| | - Xuehua Li
- Image Center, Yantai Yuhuangding Hospital, Yantai, Shangdong 264000, P.R. China
| | - Guimei Qu
- Pathology Department, Yantai Yuhuangding Hospital, Yantai, Shangdong 264000, P.R. China
| | - Tiangang Leng
- Image Center, Yantai Yuhuangding Hospital, Yantai, Shangdong 264000, P.R. China
| | - Junzu Geng
- Image Center, Yantai Yuhuangding Hospital, Yantai, Shangdong 264000, P.R. China
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15
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Primary Clear Cell Carcinoma of the Urinary Bladder. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:593826. [PMID: 27379325 PMCID: PMC4897347 DOI: 10.1155/2014/593826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/17/2022]
Abstract
Primary clear cell carcinoma of the urinary bladder (PCCUB) is rare. Literature review has revealed 47 cases of PCCUB which commonly affects women. The histogenesis of PCCUB is not certain and Müllerian origin and urotheilal origin have been postulated. The microscopic characteristics of PCCUB include cells with abundant clear cytoplasm, arranged in a solid, glandular, tubulocystic, or papillary pattern. The cells may be flat or cuboidal with abundant clear eosinophilic cytoplasm. Hobnailing may be evident. PCCUB, on immunohistochemistry, stain positively with pan-cytokeratin, cytokeratin 7, and CA 125. PCCUB may manifest with visible haematuria, lower urinary tract symptoms, and discharge. There is no consensus opinion regarding the best treatment option for PCCUBs and patient outcomes are not very clear. Surgery has been the adopted treatment of choice. Differential diagnoses of PCCUB include nephrogenic metaplasia, urothelial carcinoma with clear cell cytoplasm, diffuse large B-cell lymphoma, and metastatic clear cell carcinoma with the primary originating elsewhere. Conclusions. A thorough radiological imaging assessment is required in cases of PCCUB to exclude a primary tumour elsewhere. Urologists and oncologists should report cases of PCCUB they encounter and should enter them into a multicentric trial to ascertain the best management option.
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Mehra R, Vats P, Kalyana-Sundaram S, Udager AM, Roh M, Alva A, Pan J, Lonigro RJ, Siddiqui J, Weizer A, Lee C, Cao X, Wu YM, Robinson DR, Dhanasekaran SM, Chinnaiyan AM. Primary urethral clear-cell adenocarcinoma: comprehensive analysis by surgical pathology, cytopathology, and next-generation sequencing. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:584-91. [PMID: 24389164 PMCID: PMC3936309 DOI: 10.1016/j.ajpath.2013.11.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/18/2013] [Accepted: 11/19/2013] [Indexed: 12/11/2022]
Abstract
Primary clear-cell adenocarcinoma of the urethra, a rare tumor that histomorphologically resembles clear-cell carcinoma of the female genital tract, occurs predominantly in women and is associated with a relatively poor prognosis. The histogenesis of this rare urethral neoplasm has not been completely resolved, but it is thought to arise from either müllerian rests or metaplastic urothelium. Herein, we present comprehensive surgical pathological and cytopathological findings from a patient with primary urethral clear-cell adenocarcinoma and describe next-generation sequencing results for this patient's unique tumor-the first such reported characterization of molecular aberrations in urethral clear-cell adenocarcinoma at the transcriptomic and genomic levels. Transcriptome analysis revealed novel gene fusion candidates, including ANKRD28-FNDC3B. Whole-exome analysis demonstrated focal copy number loss at the SMAD4 and ARID2 loci and 38 somatic mutations, including a truncating mutation in ATM and a novel nonsynonymous mutation in ALK.
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Affiliation(s)
- Rohit Mehra
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan.
| | - Pankaj Vats
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Shanker Kalyana-Sundaram
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Aaron M Udager
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael Roh
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Ajjai Alva
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jincheng Pan
- Michigan Center for Translational Pathology, Ann Arbor, Michigan; Department of Urology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Robert J Lonigro
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Alon Weizer
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Cheryl Lee
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | - Xuhong Cao
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Yi-Mi Wu
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | - Dan R Robinson
- Michigan Center for Translational Pathology, Ann Arbor, Michigan
| | | | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan; Michigan Center for Translational Pathology, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan; Howard Hughes Medical Institute, Ann Arbor, Michigan
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17
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Clear cell adenocarcinoma of the renal pelvis in a male patient. Case Rep Pathol 2014; 2013:494912. [PMID: 24455377 PMCID: PMC3884960 DOI: 10.1155/2013/494912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022] Open
Abstract
Carcinoma of the renal pelvis is an uncommon renal neoplasm. Clear cell adenocarcinoma in the urinary tract is rare and has a histomorphology resembling that of the female genital tract. We herein present a case of clear cell adenocarcinoma of the renal pelvis, which is the first example in a male patient to our knowledge. A 54-year-old man presented with right flank pain. The tumor was associated with renal stones and hydronephrosis and invaded into the peripelvic fat tissue with regional lymph node metastasis. The patient died of metastatic disease six months postoperatively. Histologically, the tumor showed complex papillary architecture lined with clear and hobnail cells. Clear cell adenocarcinoma of the renal pelvis may pose a diagnostic challenge on histological grounds, particularly in the distinction from renal cell carcinoma. The immunohistochemical stains could help confirm the diagnosis. Due to its rarity, an effective treatment regimen remains to be determined.
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18
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Clear cell adenocarcinoma of urinary bladder in an area of endosalpingiosis (mullerianosis). Pathology 2014. [DOI: 10.1097/01.pat.0000443529.71743.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Alexiev BA, Tavora F. Histology and immunohistochemistry of clear cell adenocarcinoma of the urethra: histogenesis and diagnostic problems. Virchows Arch 2013; 462:193-201. [PMID: 23307189 DOI: 10.1007/s00428-012-1363-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 11/29/2012] [Accepted: 12/20/2012] [Indexed: 12/25/2022]
Abstract
Clear cell adenocarcinoma (CCAC) of the urethra is a rare neoplasm, morphologically identical to its homologue arising in the female genital tract. The histogenesis of this neoplasm is uncertain. We present clinical, histopathologic, and immunohistochemical findings of four CCAC of the urethra and discuss the histogenesis and difficulties in diagnosis and differential diagnosis. CCAC of the urethra occurred in females (4/4). Two neoplasms were identified in urethral diverticulum; one of the two cases, in close proximity to a nephrogenic adenoma. CCAC exhibited tubulocystic, papillary, and diffuse/solid growth patterns. The neoplastic cells were cuboidal or columnar with eosinophilic or clear cytoplasm, and nuclear pleomorphism of at least moderate degree. Hobnail features and tumor necrosis were also observed. CCAC expressed p53 (4/4), AMACR (3/4), vimentin (3/4), PAX8 (2/4), CK7 (2/4), cytokeratin 34betaE12 (2/4), RCC (1/4), and CK20 (1/4) and were negative for PSA, WT1, ER, CA 125, uroplakin III, p16, and p63. The immunohistochemical profile supports a possible renal tubular cell differentiation/mesonephric origin for some urethral CCAC. Nephrogenic adenoma and metastatic clear cell carcinoma are the most important differential diagnostic considerations. Multicenter studies on more cases may improve our understanding of this malignancy.
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Affiliation(s)
- Borislav A Alexiev
- Department of Pathology, NBW85, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD 21201, USA.
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20
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Derksen JW, Visser O, de la Rivière GB, Meuleman EJ, Heldeweg EA, Lagerveld BW. Primary urethral carcinoma in females: an epidemiologic study on demographical factors, histological types, tumour stage and survival. World J Urol 2012; 31:147-53. [DOI: 10.1007/s00345-012-0882-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/02/2012] [Indexed: 11/25/2022] Open
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21
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Han JY, Kim KH, Kim L, Choi SJ, Park IS, Kim JM, Chu YC, Yoon SM. Cytologic findings of clear cell adenocarcinoma of the urethra: a case report. KOREAN JOURNAL OF PATHOLOGY 2012; 46:210-4. [PMID: 23110004 PMCID: PMC3479785 DOI: 10.4132/koreanjpathol.2012.46.2.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 02/06/2012] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
Abstract
Clear cell adenocarcinoma of the urethra is a rare disease entity with an uncertain histogenesis. Here, we present a case of primary clear cell adenocarcinoma of the female urethra with its cytological findings. A 54-year-old woman presented with a painless gross hematuria lasting 3 months. On vaginal sonography, there was a sausage-like, elongated mass in the urethra, measuring 3.8×4.3 cm. The voided urine cytology revealed small clusters of rounded or papillary cells. The necrotic debris and inflammatory cells were present within some clusters of tumor cells. These tumor cells were enlarged and had abundant clear or granular cytoplasm with cytoplasmic vacuoles. The nucleus was granular and contained vesicular chromatin with prominent nucleoli. The hobnail cells and hyaline globules were also present as in a histologic section. The histologic findings were compatible with clear cell adenocarcinoma. The tumor showed distinctive cytological features. Cytologically, however, it is necessary to make a differential diagnosis from other adenocarcinoma or high-grade urothelial carcinoma.
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Affiliation(s)
- Jee-Young Han
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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22
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Abstract
Nephrogenic adenoma (NA) is an uncommon and intriguing lesion in the urinary tract. The pathogenesis of NA is not entirely clear. NA was considered to be a metaplastic process of the urothelium in response to chronic irritation of the urinary tract. However, recent evidence has shown that NA is not a metaplastic lesion but rather a proliferation of exfoliated and implanted renal epithelial cells in the urinary tract. Histologically, NAs exhibit, singly or in combination, tubules, small papillae, and microcystic structures lined by cells with little cytological atypia and focal hobnail changes. Solid formations and compressed spindled cells within a fibromyxoid background are rarely observed. Differential diagnosis includes, but is not limited to, malignant neoplasms occurring at the same sites, in particular urothelial carcinoma with deceptively bland morphology (with small tubules, microcystic and nested variants), prostatic adenocarcinoma, and clear cell adenocarcinoma. Immunohistochemical studies with antibodies targeting members of the paired box gene family (PAX2 and/or PAX8) in NAs may be helpful in the differential diagnosis of urothelial lesions and prostatic adenocarcinoma. NAs are most likely to be confused with clear cell adenocarcinoma, especially in small biopsy specimens. This is confounded by both lesions being frequently positive for PAX2, PAX8, and CK7 and not infrequently positive for p504S (α-methylacyl-CoA-racemase, AMACR) by immunohistochemistry. Recognition of its characteristic morphological patterns and awareness of its unusual architectural and cytological features are important in making the diagnosis of NA and distinguishing this lesion from its mimickers.
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23
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Liu SV, Truskinovsky AM, Dudek AZ, Ramanathan RK. Metastatic Clear Cell Adenocarcinoma of the Urethra in a Male Patient: Report of a Case. Clin Genitourin Cancer 2012; 10:47-9. [DOI: 10.1016/j.clgc.2011.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/20/2011] [Accepted: 10/04/2011] [Indexed: 11/30/2022]
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24
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Lu J, Xu Z, Jiang F, Wang Y, Hou Y, Wang C, Chen Q. Primary clear cell adenocarcinoma of the bladder with recurrence: a case report and literature review. World J Surg Oncol 2012; 10:33. [PMID: 22325372 PMCID: PMC3305464 DOI: 10.1186/1477-7819-10-33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/10/2012] [Indexed: 11/25/2022] Open
Abstract
Clear cell carcinoma of the bladder is a rare tumor of the bladder. There are few reports available on this rare disease, and no cases with recurrence were reported. Here we present a case of 68-year-old woman with primary clear cell carcinoma of the bladder, who underwent repeat TUR-BT and tumor recurrence. We also reviewed the previous treatments and prognoses in previous case reports and evaluate the proper treatment for this disease. Once the diagnosis is determined, the radical surgery should be recommended. The recurrence is not prevented based on post-TUR intravesical therapy.
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Affiliation(s)
- Ji Lu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
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25
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Clinical utility of immunohistochemistry in the diagnoses of urinary bladder neoplasia. Appl Immunohistochem Mol Morphol 2011; 18:401-10. [PMID: 20505509 DOI: 10.1097/pai.0b013e3181e04816] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Urothelial carcinomas demonstrate diverse morphologic and immunologic features that frequently lead to diagnostic challenges. Recent advances have identified a number of immunohistochemical stains that, when used in the context of a panel, can be a valuable tool in properly classifying primary urothelial carcinoma and carcinomas secondarily involving the urinary bladder. In addition, new biomarkers prove helpful in the staging of bladder carcinoma. In this article, we review the clinical utility of immunohistochemistry in a series of diagnostic scenarios, including flat urothelial lesions with atypia, rare variants of urothelial carcinoma, primary adenocarcinoma versus secondary colorectal tumors, distinguishing prostate from urothelial carcinoma, and the utility of smoothelin in staging bladder carcinoma. Emphasis is placed on panels of commonly used biomarkers to establish diagnoses.
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26
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Williamson SR, Lopez-Beltran A, Montironi R, Cheng L. Glandular lesions of the urinary bladder:clinical significance and differential diagnosis. Histopathology 2010; 58:811-34. [DOI: 10.1111/j.1365-2559.2010.03651.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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27
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Herawi M, Drew PA, Pan CC, Epstein JI. Clear cell adenocarcinoma of the bladder and urethra: cases diffusely mimicking nephrogenic adenoma. Hum Pathol 2010; 41:594-601. [PMID: 20060152 DOI: 10.1016/j.humpath.2009.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 10/06/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
Abstract
Although clear cell adenocarcinoma have been described focally mimicking nephrogenic adenoma, we have identified a subset of clear cell adenocarcinoma that diffusely resembles nephrogenic adenoma (nephrogenic adenoma-like clear cell adenocarcinoma). Twelve classic clear cell adenocarcinomas of the bladder and urethra and 7 nephrogenic adenoma-like clear cell adenocarcinomas were compared to 10 nephrogenic adenomas. Classic clear cell adenocarcinomas and nephrogenic adenoma-like clear cell adenocarcinomas comprised 4 men and 15 women. The following features were seen in classic clear cell adenocarcinomas: nephrogenic adenoma-like clear cell adenocarcinomas: predominantly solid pattern (7/12:0/7), marked nuclear pleomorphism (7/12:1/7), prominent nucleoli (5/12:1/7), clear cytoplasm in 50% or greater of tumor (7/12:0/7), and necrosis (8/12:3/7), although the necrosis in nephrogenic adenoma-like clear cell adenocarcinomas was often focal and intraluminal. Both patterns of clear cell adenocarcinomas showed prominent hobnail features, although more pronounced in nephrogenic adenoma-like clear cell adenocarcinomas. Muscularis propria invasion was seen in 5 of 9 classic clear cell adenocarcinomas and 6 of 6 nephrogenic adenoma-like clear cell adenocarcinomas, where evaluable. Classic clear cell adenocarcinoma was associated with urothelial carcinoma (n = 2) and endometriosis (n = 1). The Ki-67 rate in clear cell adenocarcinomas ranged from 10% to 80% compared with 0% to 5% in nephrogenic adenoma. The following antibodies were not helpful in distinguishing nephrogenic adenoma-like clear cell adenocarcinoma from nephrogenic adenoma: CD10, estrogen receptor, p63, high-molecular-weight cytokeratin, and alpha-methylacyl coenzyme-A racemase. PAX2 expression was more frequent in nephrogenic adenoma (89%) compared to both patterns of clear cell adenocarcinoma (29%-32%). The key features discriminating between nephrogenic adenoma-like clear cell adenocarcinoma and nephrogenic adenoma include occasional clear cells, more prominent pleomorphism especially hyperchromatic enlarged nuclei, and extensive muscular invasion. Presence of mitoses and a high rate of Ki-67 expression in lesions resembling nephrogenic adenoma require clinical correlation, close follow-up, and repeat biopsy with more extensive sampling.
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Affiliation(s)
- Mehsati Herawi
- Department of Pathology, Harper University Hospital, Wayne State University School of Medicine, and Karmanos Cancer Institute, Detroit, MI 48201, USA
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28
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Shih CM, Huang CT, Chi CH, Lin JW, Pan CC. CA125-producing clear cell adenocarcinoma arising from the upper ureter and renal pelvis. J Chin Med Assoc 2010; 73:40-3. [PMID: 20103490 DOI: 10.1016/s1726-4901(10)70020-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Clear cell adenocarcinomas similar to those found in the female genital organs can arise in the lower urinary tract of both women and men. Clear cell adenocarcinomas occurring in the upper urinary system are exceedingly rare. Here, we present a case of clear cell adenocarcinoma arising from the upper ureter and renal pelvis of a postmenopausal woman with a ureteral stone. The patient had elevated serum levels of cancer antigen (CA) 125 (103.80 U/mL) and CA19-9 (151.96 U/mL). The tumor showed typical features of tubulopapillary structures lined with clear-to-eosinophilic cytoplasm and frequent hobnail configuration. The tumor cells were immunoreactive for cytokeratin 7, cytokeratin 20, carcinoembryonic antigen and CA125, but negative for PAX-2 and alpha-methylacyl coenzyme A racemase. Given the presence of intestinal and squamous metaplasia of the adjacent urothelium, we propose that this clear cell adenocarcinoma developed through a metaplastic process. The tumor behaved so aggressively that the patient developed multiple metastases and died of the disease 5 months after radical nephroureterectomy.
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Affiliation(s)
- Chi-Min Shih
- Department of Anatomical Pathology, St. Josephs Hospital, Yunlin, Taiwan, R.O.C
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29
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Clear cell carcinoma of the lower urinary tract in a male patient. Presentation and update on histogenesis and management. Pathol Int 2009; 59:595-7. [DOI: 10.1111/j.1440-1827.2009.02413.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Adeniran AJ, Tamboli P. Clear cell adenocarcinoma of the urinary bladder: a short review. Arch Pathol Lab Med 2009; 133:987-91. [PMID: 19492895 DOI: 10.5858/133.6.987] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2008] [Indexed: 11/06/2022]
Abstract
In this short review, we discuss clear cell adenocarcinoma of the urinary bladder, a rare tumor that primarily affects women. The histogenesis of this neoplasm is uncertain; in some tumors the clinicopathologic and histologic features are suggestive of a müllerian origin. Clear cell adenocarcinoma consists of cells with abundant clear cytoplasm, arranged in solid, glandular, or tubulocystic patterns. These tumors are positive for pancytokeratin, cytokeratin 7, and CA 125 immunohistochemical stains. Patients typically present with gross hematuria, dysuria, and discharge. The natural history is poorly understood and patient outcomes remain unclear. Currently, surgery is the treatment of choice. Nephrogenic adenoma is the most important differential diagnostic consideration, followed by metastatic clear cell carcinoma.
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31
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Miller J, Karnes RJ. Primary clear-cell adenocarcinoma of the proximal female urethra: case report and review of the literature. Clin Genitourin Cancer 2008; 6:131-3. [PMID: 18824439 DOI: 10.3816/cgc.2008.n.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary carcinoma of the female urethra is a rare entity. Adenocarcinomas account for only 10% of cases. Clear cell adenocarcinoma (CCA) of the urethra is more common among women than men.1 We report a case of primary CCA of the urethra and review the literature concerning the histogenesis, management, and outcome of this uncommon tumor.
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Affiliation(s)
- Joe Miller
- Southern Illinois University School of Medicine, Springfield, IL, USA.
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32
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Affiliation(s)
- Christina M Bagby
- Institute of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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33
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Sun K, Huan Y, Unger PD. Clear cell adenocarcinoma of urinary bladder and urethra: another urinary tract lesion immunoreactive for P504S. Arch Pathol Lab Med 2008; 132:1417-22. [PMID: 18788852 DOI: 10.5858/2008-132-1417-ccaoub] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Clear cell carcinoma of the urinary bladder/ urethra is a rare tumor histologically resembling the neoplasms in the female genital tract. Adequate characterization of this tumor has been hampered by its rarity. alpha-Methylacyl-CoA racemase (AMACR)/P504S has been reported to be positive in prostatic adenocarcinoma, papillary renal cell carcinoma, and gastrointestinal neoplasmas; however, it has never been studied in clear cell carcinoma of the lower urinary tract. OBJECTIVE To investigate the immunohistochemical staining profile in 4 primary clear cell carcinomas of the urinary tract, including P504S, which has not been previously evaluated in these tumors. DESIGN Four cases of clear cell adenocarcinoma were retrieved from our archives: 2 cases from the urinary bladder (one each from a man and a woman) and 2 cases from the urethra (both from women, 1 in a diverticulum). Immunohistochemistry performed on the cases were P504S, K903, cytokeratin (CK) 7, CK20, CA 125, and p63. RESULTS We found that clear cell carcinomas had a distinct immunoreactive profile: strongly positive for P504S, K903, and CK7, and negative for p63. Two cases were also positive for CA 125 and CK20. CONCLUSION The immunohistochemical profile of clear cell carcinomas shares some similarity to conventional urothelial carcinoma; however, it deviates from those tumors in being positive for P504S and negative for p63. This staining profile may suggest a nonurothelial origin for these tumors, may serve as a useful tool in the differential diagnosis of this tumor, and may reflect its etiology. Because similar expression of P504S is also seen in nephrogenic adenomas, this marker should not be used to differentiate nephrogenic adenomas from clear cell adenocarcinomas.
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Affiliation(s)
- Katherine Sun
- Department of Anatomic and Clinical Pathology, The Mount Sinai Medical Center, New York, NY 10029-6574, USA.
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34
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Expression of PAX8 in nephrogenic adenoma and clear cell adenocarcinoma of the lower urinary tract: evidence of related histogenesis? Am J Surg Pathol 2008; 32:1380-7. [PMID: 18670350 DOI: 10.1097/pas.0b013e31816b1020] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent evidence has showed that nephrogenic adenoma is a true "nephrogenic" lesion derived from the proliferation of exfoliated and implanted renal tubular cells in the urinary tract, a process that closely resembles the formation of endometriosis. This new concept has led to the identification of renal transcription factor PAX2 as a diagnostic marker for nephrogenic adenoma. PAX8 is another transcription factor structurally and functionally related to PAX2. Both are cell lineage restricted transcription factors expressed in normal and neoplastic tissues of related origin, including renal tubular cells in both fetal and adult kidneys. In this study, we investigated the expression of PAX8 in nephrogenic adenoma and its mimics. We report here that PAX8 was detected in all nephrogenic adenomas (N=35) and clear cell adenocarcinoma of the lower urinary tract (N=7), but not in prostate adenocarcinoma (N=100), adenocarcinoma (N=9), squamous cell carcinoma (N=5), or urothelial carcinoma (N=48) of the urinary bladder and its variants. PAX8 was neither detected in normal urothelium of the urinary bladder nor in prostate glands and stroma. PAX2 was also detected in 2 of the 7 clear cell adenocarcinomas of the lower urinary tract. We suggest that PAX8 is an additional marker for identifying nephrogenic adenoma. Expression of PAX8 or PAX2 in both nephrogenic adenoma and clear cell adenocarcinoma of the lower urinary tract may indicate a possible related tissue origin for these 2 lesions; both may be derived from proliferating renal tubular cells in the urinary tract. In addition, detection of PAX8 or PAX2 in clear cell adenocarcinoma of the lower urinary tract is helpful in differentiating it from urothelial carcinoma and its variants and adenocarcinomas of the urinary bladder or of the prostate.
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35
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Sung MT, Zhang S, MacLennan GT, Lopez-Beltran A, Montironi R, Wang M, Tan PH, Cheng L. Histogenesis of clear cell adenocarcinoma in the urinary tract: evidence of urothelial origin. Clin Cancer Res 2008; 14:1947-55. [PMID: 18381932 DOI: 10.1158/1078-0432.ccr-07-4147] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Clear cell adenocarcinoma in the urinary tract is a rare entity with an appearance resembling its counterpart in the female genital tract. Although several theories have been proposed about its origin, its exact histogenesis has remained uncertain. EXPERIMENTAL DESIGN We integrated molecular genetic evaluation by fluorescence in situ hybridization and X-chromosome inactivation with conventional morphologic and immunohistochemical analyses in 12 patients with clear cell adenocarcinomas in the urinary tract. RESULTS Concurrent urothelial carcinoma or urothelial carcinoma in situ was present in six cases (50%) and foci of cystitis glandularis were observed in four cases (33%). Neither intestinal metaplasia nor Müllerian component was identified in any case. Cytoplasmic expression of alpha-methylacyl-CoA racemase was demonstrable in 10 of 12 tumors (83%). Moderate to diffuse immunostaining for cytokeratin 7 was identified in all 12 tumors (100%), whereas only 3 of 12 (25%) tumors showed positive immunostaining for cytokeratin 20. Focal uroplakin III staining was seen in 6 of 12 tumors (50%). In five cases (42%), focal to moderate CD10 immunoreactivity was observed. Immunostains for OCT4 and CDX2 were completely negative in all tumors. In UroVysion fluorescence in situ hybridization assays, all tumors displayed chromosomal alterations similar to those commonly found in urothelial carcinoma. Identical patterns of nonrandom X-chromosome inactivation in concurrent clear cell adenocarcinoma and urothelial neoplasia were identified in two informative female cases. CONCLUSIONS Our findings support an urothelial origin for most clear cell adenocarcinomas of the urinary tract, despite their morphologic resemblance to certain Müllerian-derived tumors of the female genital tract.
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Affiliation(s)
- Ming-Tse Sung
- Department of Pathology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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36
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Abascal Junquera JM, Cecchini Rosell L, Martos Calvo R, Salvador Lacambra C, Celma Doménech A, De Torres I, Morote Robles J. [Presentation of a new case of primary clear cell adenocarcinoma of the urethra and its surgical management]. Actas Urol Esp 2007; 31:411-6. [PMID: 17633929 DOI: 10.1016/s0210-4806(07)73657-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. MATERIAL AND METHODS We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. CONCLUSIONS It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.
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Adams B, Sawhney R, Sheil A, Chaudhary UB. A Rare Case of Clear Cell Adenocarcinoma of the Bladder with Unique Pathological Features. Am J Med Sci 2007; 333:63-5. [PMID: 17220697 DOI: 10.1097/00000441-200701000-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clear cell adenocarcinomas of the urinary bladder are rare tumors with an unknown histogenesis. Since these tumors appear histologically similar to clear cell tumors of the female genital tract, a mullerian histogenesis has been proposed. Several publications have examined the immunohistochemical properties of clear cell adenocarcinomas to improve understanding of the cause and pathogenesis of this tumor. While specific criteria for a diagnosis of clear cell adenocarcinoma have not been defined, there are consistent staining patterns suggested for characterization. We present an important case of clear cell adenocarcinoma of the bladder with a unique staining pattern. We review the literature and discuss the differential diagnosis and various theories concerning the origin of this rare tumor.
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Affiliation(s)
- Betsy Adams
- Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Kuroda N, Shiotsu T, Ohara M, Hirouchi T, Mizuno K, Miyazaki E. Female urethral adenocarcinoma with a heterogeneous phenotype. Case report. APMIS 2006; 114:314-8. [PMID: 16689832 DOI: 10.1111/j.1600-0463.2006.apm_345.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We here report a very rare case of female urethral adenocarcinoma. A 77-year-old woman presented with urinary retention. Cystoscopy showed a urethral tumor and the biopsy material showed adenocarcinoma. Macroscopically, the tumor measuring 3.0 x 3.0 x 2.4 cm was predominantly observed around the periurethral area on the proximal side. Histologically, patterns of columnar/mucinous adenocarcinoma, clear cell adenocarcinoma and papillary/micropapillary carcinoma were observed, but there was no evidence of a cribriform pattern. Immunohistochemically, neoplastic cells of at least one of three components were positive for CK7 and CK20 or CA125. We suggest that female urethral adenocarcinoma with a histologically and immunohistochemically heterogeneous phenotype may originate from cells within urethral or paraurethral tissue, such as urethritis glandularis or intestinal metaplastic epithelium and Mullerian tissue.
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Affiliation(s)
- N Kuroda
- Department of Pathology and Laboratory Medicine, Kochi Red Cross Hospital, Kochi, Japan
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Hartmann A, Junker K, Dietmaier W, Schröder S, Lopez D, Hofstädter F, Blaszyk H. Molecular evidence for progression of nephrogenic metaplasia of the urinary bladder to clear cell adenocarcinoma. Hum Pathol 2005; 37:117-20. [PMID: 16360424 DOI: 10.1016/j.humpath.2005.09.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 08/11/2005] [Accepted: 09/19/2005] [Indexed: 11/17/2022]
Abstract
Nephrogenic metaplasia or nephrogenic adenoma of the urinary tract may present a diagnostic challenge in surgical pathology practice. Previous case reports suggest the possibility of nephrogenic metaplasia progressing to clear cell adenocarcinoma, but a malignant potential of nephrogenic metaplasia is generally not acknowledged. A case of a 70-year-old female patient with multiple recurrences of nephrogenic metaplasia of the urinary bladder and subsequent development of clear cell adenocarcinoma is described. Immunohistochemical studies help to differentiate the 2 entities. Results of molecular studies, particularly comparative genomic hybridization analysis, suggest clonal evolution of nephrogenic metaplasia to clear cell adenocarcinoma in this case.
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Affiliation(s)
- Arndt Hartmann
- Institute of Pathology, University of Regensburg, D-93042, Germany
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Abstract
Clear cell adenocarcinoma of the lower urinary tract, and particularly of the bladder, is a rare neoplasm and its histogenesis remains obscure. The authors report the clinical and pathologic findings of a 55-year-old male with clear cell carcinoma of the bladder. The histogenesis of the tumor is discussed, and 35 cases reported in the literature are reviewed.
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Affiliation(s)
- Mustafa Kösem
- Department of Pathology, Yüzüncü Yil University, Vann, Turkey.
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Abstract
Primary carcinoma of the male urethra accounts for less than 1% of malignancies in males. Mucinous adenocarcinoma of the urethra is extremely rare, and its biologic behavior is not well known. We report a case of mucinous adenocarcinoma showing the histologic features of colloid adenocarcinoma that appears to have evolved either by neoplastic degeneration of goblet cells found in the urethral epithelium or by malignant degeneration of persistent glandular elements of uretheritis cystica and glandularis.
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Affiliation(s)
- Rosenblat Yvgenia
- Department of Pathology, Sackler Faculty of Medicine, Sackler School of Medicine, Hasharon Hospital, Petah Tikva, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
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Gualco G, Ortega V, Ardao G, Cravioto F. Clear cell adenocarcinoma of the prostatic utricle in an adolescent. Ann Diagn Pathol 2005; 9:153-6. [PMID: 15944958 DOI: 10.1016/j.anndiagpath.2005.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present a case of a 16-year-old boy with a primary clear cell adenocarcinoma of the prostatic utricle. The patient presented with a 6-month history of intermittent, nonpainful, gross hematuria and an associated right renal agenesis. Radiographic studies revealed the presence of a solid and cystic mass between the bladder neck and the cranium of the prostate. Serum tests, including prostate-specific antigen, carcinoembryonic antigen, CA-19-9, and human chorionic gonadotropin, were performed and found to be within normal limits. A surgical resection of the mass including prostate and seminal vesicles was performed. Grossly, a polypoid exophytic tumor was present at the prostatic utricle. Histologically, the tumor shows the classical clear cell morphology reminiscent of the so-called mesonephric adenocarcinomas. At clinical follow-up, the patient is alive and well 18 months after surgical resection. The present case highlights an unusual phenomenon of the development of an unusual form of adenocarcinoma in an adolescent.
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Affiliation(s)
- Gabriela Gualco
- Department of Pathology, Central Armed Forces Hospital, Montevideo, MDEO 11600, Uruguay.
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Abstract
Clear cells have been described in many tumors of varying differentiation. Although clear cell carcinoma is well-recognized in the lower urinary and female genital tracts, its occurrence in the gastrointestinal tract and related structures is uncommon. There have been only a few case reports and small series reporting this morphologic phenomenon in the stomach, colon, and biliary tract. Clear cell carcinoma of the endometrium has been associated with poor prognosis, but the prognostic significance of clear cells in gastric adenocarcinoma is unknown. Herein we describe three cases of clear cell, glycogen-rich, gastric adenocarcinoma and evaluate the frequently used classification systems for gastric cancer. Two tumors showed a tubulopapillary pattern and one showed a predominantly diffuse sheet-like growth. The proliferation (MIB) index in all cases was approximately 20%. Only case 1 showed focal staining for alpha-fetoprotein and both cases 1 and 2 showed focal carcinoembryonic antigen reactivity. In conclusion, we describe three cases of clear cell gastric carcinoma that presented as high-stage disease.
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Affiliation(s)
- Dhirendra Govender
- Department of Pathology, Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa
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Pongtippan A, Malpica A, Levenback C, Deavers MT, Silva EG. Skene's Gland Adenocarcinoma Resembling Prostatic Adenocarcinoma. Int J Gynecol Pathol 2004; 23:71-4. [PMID: 14668555 DOI: 10.1097/01.pgp.0000101144.79462.39] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An 88-year-old woman presented with gross hematuria and a 3-cm periurethral mass. Biopsy revealed an adenocarcinoma resembling prostatic adenocarcinoma; the tumor cells were positive for keratin and prostate-specific antigen. The serum level of prostate-specific antigen was elevated; the carcinoembryonic antigen and CA-125 serum levels were normal. One year after external beam radiotherapy, the patient is without evidence of disease. This is the sixth case of a urethral prostatic-type adenocarcinoma, tumors that are most likely of Skene's gland origin.
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Affiliation(s)
- Atcharaporn Pongtippan
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA
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Abstract
A rare case of clear cell adenocarcinoma within a bladder diverticulum is presented. A 69-year-old man presented to our institution with gross hematuria. Workup, including computed tomography and cystoscopy, revealed a papillary bladder mass within a bladder diverticulum near the right ureteral orifice. Biopsy of the tumor was performed, and the pathologic examination revealed clear cell adenocarcinoma. He underwent bladder diverticulectomy and remained disease free at 1 year of follow-up. The clinicopathologic characteristics of this entity compared with its most difficult pathologic differential diagnosis, nephrogenic adenoma, are reviewed.
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Kiyokawa H, Koyama M, Kato H. Adenocarcinoma of the prostate immunostained for carbohydrate antigen 125 and carcinoembryonic antigen. BJU Int 2003; 91:298-9. [PMID: 12581025 DOI: 10.1046/j.1464-410x.2003.04063.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- H Kiyokawa
- Department of Urology, Komorokousei General Hospital, 3-2-31 Yora, Komoro 384-8588, Japan.
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Oliva E, Amin MB, Jimenez R, Young RH. Clear cell carcinoma of the urinary bladder: a report and comparison of four tumors of mullerian origin and nine of probable urothelial origin with discussion of histogenesis and diagnostic problems. Am J Surg Pathol 2002; 26:190-7. [PMID: 11812940 DOI: 10.1097/00000478-200202000-00005] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carcinomas of the bladder that resemble clear cell carcinoma of mullerian type are rare. Whether such neoplasms 1) arise from mullerian elements in the bladder and are histogenetically identical to the female genital tract cancer, 2) are a peculiar variant of vesical adenocarcinoma of nonmullerian derivation, or 3) represent a peculiar morphologic expression of transitional cell (urothelial) carcinoma with gland differentiation is often uncertain. We reviewed the clinical, conventional pathologic, and immunohistochemical features of 13 neoplasms with exclusive, or predominant, morphologic features of clear cell carcinoma. The 11 female and two male patients were 22-83 (mean 57) years of age. The clinical and gross features had no unique aspects. On microscopic examination the most common pattern, present in all cases, was tubulocystic, with a papillary pattern, present in six tumors and a predominant solid growth in one. Cells with abundant clear cytoplasm were conspicuous in nine tumors and hobnail cells were seen in eight. Four tumors showed focally recognizable patterns of transitional cell (urothelial) carcinoma in the available material. In five other tumors pseudostratified epithelium reminiscent of transitional epithelium was present focally. Endometriosis was present in two cases. In two other cases benign cysts focally lined by ciliated epithelium and surrounded by elastosis were interpreted as most likely mullerian. Immunohistochemistry was performed in 10 cases. All tumors stained for CA 125 (usually strong, ranging from focal to diffuse) and nine tumors stained for CK7 (usually strong and diffuse). CK20 was focally and weakly positive in four tumors and extensively positive in another. The same immunohistochemical panel was performed on 10 typical transitional cell carcinomas, 4 transitional cell carcinomas with gland differentiation, not otherwise specified, and 5 pure adenocarcinomas of the bladder (one of urachal origin). Minimal CA 125 positivity was seen in two transitional cell carcinomas. CA 125 staining was seen in the areas of gland differentiation in three of four transitional cell carcinomas and three of five pure adenocarcinomas but was focal in most cases. All transitional cell carcinomas and transitional cell carcinomas with gland differentiation showed extensive CK7 positivity. In contrast, only one of four positive pure adenocarcinomas showed >5% CK7-positive cells. Although all groups showed CK20 positivity, the percentage of CK20 positive cells was higher in pure adenocarcinomas. Prostate specific antigen was negative in all tumors. The cytokeratin immunoprofile of clear cell carcinomas of the bladder is closer to transitional cell carcinomas and transitional cell carcinomas with gland differentiation than pure adenocarcinomas arguing against an unusual form of adenocarcinoma. Our finding of CA 125 expression in bladder tumors of apparent urothelial origin contrasts with some studies that have regarded CA 125 expression as evidence for a mullerian origin. The frequency of gland differentiation in transitional cell carcinomas and the rarity of vesical endometriosis could be taken to suggest that these tumors are mostly of urothelial derivation, but the strong female preponderance in our series argues for a mullerian origin in at least some cases, and this is almost certain in the four cases with benign mullerian components. In the absence of endometriosis or conventional foci of transitional cell carcinoma, it may be impossible to determine whether a tumor with the morphology of clear cell carcinoma is of mullerian or transitional (urothelial) cell lineage, and at this time immunochemistry does not solve this problem.
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Affiliation(s)
- Esther Oliva
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, Harvard Medical School, Fruit Street, Boston, MA 02114, USA.
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Vang R, Whitaker BP, Farhood AI, Silva EG, Ro JY, Deavers MT. Immunohistochemical analysis of clear cell carcinoma of the gynecologic tract. Int J Gynecol Pathol 2001; 20:252-9. [PMID: 11444201 DOI: 10.1097/00004347-200107000-00008] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clear cell carcinoma of the gynecologic tract has been defined in terms of its clinical and histologic features; however, its immunophenotypic profile has not been fully characterized. Seventeen cases of primary clear cell carcinoma from various sites within the female genital tract (11 ovary, 5 uterus, 1 vagina) were analyzed by immunohistochemistry. These tumors were assessed for the expression of cytokeratin 7 (CK7), cytokeratin 20 (CK20), low and high molecular weight cytokeratin, (CAM5.2 and 34 beta E12, respectively), carcinoembryonic antigen (CEA), Leu-M1, vimentin, estrogen receptor (ER), progesterone receptor (PR), bcl-2, p53, HER-2/neu, and CA-125. The characteristic immunoprofile for all sites was positivity for CK7, CAM5.2, 34 beta E12, CEA, Leu-M1, vimentin, bcl-2, p53, and CA-125; variably positivity for ER and HER-2/neu; and negativity for CK20 and PR. For comparison, two cases of urologic clear cell carcinoma (1 bladder, 1 urethra) were also studied, and their profile was found to be similar to the gynecologic cases. Aside from minor differences, clear cell carcinoma appears to have the same immunophenotype regardless of whether it originates in the endometrium, ovary, or genitourinary tract. Much of its profile is similar to other gynecologic adenocarcinomas, but some of the markers studied may be useful in the differential diagnosis of this tumor.
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Affiliation(s)
- R Vang
- Department of Pathology, University of Texas-Houston Medical School, Houston, Texas, USA
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50
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Chan YM, Ka-Leung Cheng D, Nga-Yin Cheung A, Yuen-Sheung Ngan H, Wong LC. Female urethral adenocarcinoma arising from urethritis glandularis. Gynecol Oncol 2000; 79:511-4. [PMID: 11104631 DOI: 10.1006/gyno.2000.5968] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Female urethral adenocarcinoma is extremely rare and more than one tissue of origin has been suggested other than the Skene's gland. Immunohistochemistry with cytokeratins (CK) 7 and 20 is used to define the origin of the tumor. CASE REPORT A 72-year-old woman presented with a 2-cm polypoid tumor at the external urethral meatus and bleeding. Wide local excision and bilateral inguinal lymphadenectomy were performed. Postoperative convalescence was uneventful. It was a poorly differentiated mucinous adenocarcinoma without direct urothelial involvement. There were focal areas of intestinal metaplasia. The tumor cells were positive for CK 7 and 20 and negative for prostate-specific antigen. DISCUSSION This case provides supportive evidence that mucinous urethral adenocarcinoma may arise from malignant transformation of urethritis glandularis.
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Affiliation(s)
- Y M Chan
- Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong SAR, China
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