Primary Mucinous Adenocarcinoma of the Bladder: Case Report and Review of Literature
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CASE REPORT
Primary Mucinous Adenocarcinoma of the Bladder: Case Report and Review of Literature Varadharajan Vijayakumar 1 & GaneshBabu Natesan 1 & Madhuri Sudhakar 1 & Umashankar Prakasam 1 & Vimalathithan Seeralan 1 & Muruganandham Kaliyaperumal 2 & S Rajasundaram 1 Received: 23 July 2018 / Accepted: 12 December 2019 # Indian Association of Surgical Oncology 2019
Introduction Bladder cancer is a very common cancer of the urinary system and the ninth most common type of cancer worldwide. Bladder cancers are categorized as urothelial and nonurothelial histologic types. Urothelial carcinoma (transitional-cell carcinoma) is the predominant variety with an incidence of around 90–95%. Non-urothelial histology is further subdivided as epithelial and nonepithelial. Those of epithelial origin are adenocarcinoma, squamous cell carcinoma, and small cell tumors [1]. Nonepithelial cancers are very rare and include sarcomas, paragangliomas, melanomas, and lymphomas. Squamous cell carcinoma and adenocarcinoma represent only 3 and 2% of the primary bladder cancer cases, respectively. The most common age-group affected by adenocarcinoma is around 50–60 years. Patients with bladder exstrophy or persistent remnant urachus are at a higher risk of developing vesical adenocarcinoma. Chronic inflammation of the bladder mucosa induces metaplasia to the more protective squamous cell or glandular-type epithelium. Bladder adenocarcinoma is resistant to chemotherapy and radiation, so surgery is currently considered the most effective treatment option [3]. Thus, early diagnosis is crucial. Mucinous subtype of primary bladder adenocarcinoma (PBA) is extremely rare. Progressive change from mucinous metaplasia to mucinous adenoma to mucinous adenocarcinoma has been suggested as pathogenesis [2]. Diagnostic investigations are urinary cytology, cystoscopy, and biopsy followed by histopathological
* Varadharajan Vijayakumar [email protected] 1
Department of Surgical Oncology, Gleneagles Global Institute of Oncology, Gleneagles Global Health City, Chennai 600100, India
2
Department of Urology, Gleneagles Global Health City, Chennai 600100, India
evaluation. To differentiate primary bladder adenocarcinoma from secondary type, immunohistochemistry might be helpful. Due to the unique etiopathogenesis and clinical course, management, and prognosis when compared to urothelial cancers and the relative lack of clinical reports, we herein report the case of a patient with primary mucinous adenocarcinoma of the bladder to help elucidate the characteristics of this tumor.
Case Report The patient was a 63-year-old male, nonsmoker, and nondrinker, who presented with suprapubic pain for 5 months. He had history of hematuria for past 1 month. The initial cystoscopy biopsy report was that of muscleinvasive urothelial carcinoma. As a part of staging workup, he underwent PET CT scan, which showed focal polypoidal mural thickening involving base of the bladder near the bilateral VUJ and neck of the urinary bladder without distant metastasis (Fig. 1)
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