Original contributionClear cell adenocarcinoma of the bladder and urethra: cases diffusely mimicking nephrogenic adenoma
Introduction
Clear cell adenocarcinomas (CCA) of the lower urinary tract are rare neoplasms that classically are comprised of solid areas and tubulopapillary architecture with prominent hobnail cytology [1], [2], [3], [4], [5]. It is recognized that focally within a CCA, there may be areas mimicking nephrogenic adenomas (NA), comprised primarily of tubules and papillae without significant cytological atypia [1], [3], [4], [6], [7], [8]. A distinction is usually possible by examining other areas of the tumor which show more obvious malignant features of CCA [3], [4], [6], [9]. We have identified a subset of CCA of the urinary tract where either the entire lesion or the overwhelming component of the lesion strikingly resembles NA. This subset demonstrates no significant solid growth pattern typical of classic CCA and has a more pronounced hobnail pattern. In addition, the cytological atypia seen in these lesions is less pronounced compared to classic CCA. Consequently, this nephrogenic adenoma-like CCA (NA-like CCA) may be misdiagnosed as NA, even with more extensive tissue sampling. In the current study, we present a series of NA-like CCA and compare their microscopic and immunohistochemical features with a series of classic CCA and NA.
Section snippets
Materials and methods
Twelve classic CCA of the bladder (n = 6) and urethra (n = 6) and 7 NA-like CCA arising in the urethra (n = 4) or bladder (n = 3), were studied histologically and immunophenotypically and compared to 10 NA. All but 2 cases were from either the surgical pathology archive files at The Johns Hopkins Hospital or from the personal consult files of the senior author. One case was contributed by the author P.A.D. and another by the author C.C.P. Routine formalin-fixed paraffin embedded hematoxylin and
Clinical features
Four men and 15 women with CCA had a mean age of 62 years (range, 36-91 years). Nine CCA were located in the bladder and 10 in the urethra. In contrast, with NA, there was a male predominance (8 men, 2 women) with a mean age of 53 years (range, 31 to 72 years). NA primarily involved the bladder (n = 9) with only 1 case in the urethra. Presenting symptoms, available in 12 of 19 of the CCA cases, were gross hematuria (n = 10) and urinary hesitancy (n = 2).
Patients with classic CCA consisted of 2
Discussion
CCA of the lower urinary tract is a rare type of carcinoma that arises in the urethra or bladder, predominantly in women and, in general, is regarded as an aggressive neoplasm with an associated poor prognosis [4], [5], [10]. CCA is characterized by an admixture of tubulopapillary and solid components which can focally resemble NA, especially on limited biopsy [1], [2], [6], [11]. However, a combination of features, including areas of diffuse growth pattern, abundant clear cytoplasm, and
Acknowledgment
The authors thank Luis Chiriboga, PhD, from Kaplan Comprehensive Cancer Center, New York University Medical Center, New York, NY, and Ming-Yuan Lee, MD, from Department of Pathology and Laboratory Services, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan for their contribution in PAX2 antibody workup and follow-up contribution, respectively.
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