Older Male Presented with Hematuria

Deloar Hossain, M.D.

Specimen Type:

Bladder

History:

55 year old male presented with hematuria.

Pathologic Features:

Serum PSA level was 0.5ng/ml. Cystoscopy showed a polypoid mass in the right lateral wall and was biopsied. Grossly a polypoid 0.7 cm tan tissue was received and submitted entirely in one cassette. Microscopically, the tissue consists of large polypoid glandular proliferation on the surface of the bladder wall. Invasion into the lamina propria was present (fig 1, 2, and 3). The polypoid growths were lined by columnar to cuboidal single layer of epithelium with prominent nucleoli (fig 4). Adjacent histologically unremarkable urothelium was present (fig 5).

Differential Diagnosis:

  • Urothelial carcinoma with glandular differentiation.
  • Primary adenocarcinoma of the urinary bladder.
  • Metastatic colonic carcinoma.
  • Prostate adenocarcinoma involving bladder.
  • Other uncommon metastatic carcinoma.

Diagnosis:

Prostatic adenocarcinoma involving urinary bladder mucosa.

Presence of adenocarcinoma in the bladder could be a difficult diagnostic problem. Presence or absence of histologically identifiable urothelial carcinoma is important in the separating urothelial carcinoma with glandular differentiation and primary urothelial carcinoma. Search for prominent nuclear membrane irregularity (urothelial carcinoma) and prominent nucleoli (prostate carcinoma) is helpful. Finally immunohistochemical profile is most of the cases are diagnostic (ref 1).

References:

  1. Tamboli P, Mohsin SK, Hailemariam S, Amin MB:Colonic adenocarcinoma metastatic to the urinary tract versus primary tumors of the urinary tract with glandular differentiation: a report of 7 cases and investigation using a limited immunohistochemical panel. Arch Pathol Lab Med. 2002 Sep;126(9):1057-63.