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- Title
Adenocarcinomas of the Gynecologic Tract Involving the Urinary Bladder: A Series of 16 Cases Potentially Mimicking Urothelial Malignancy.
- Authors
Russell, Daniel H.; Epstein, Jonathan I.; Kryvenko, Oleksandr N.; Schlumbrecht, Matthew; Jorda, Merce; Pinto, Andre
- Abstract
Context.--There is limited literature describing gynecologic adenocarcinomas involving the urinary bladder and potential diagnostic pitfalls. Objective.--To describe key features distinguishing metastatic (or extension of) gynecologic adenocarcinomas from urothelial carcinomas with glandular differentiation. Design.--Retrospective review of surgical pathology cases of gynecologic adenocarcinomas involving the bladder from 2 different institutions, retrieved from surgical pathology archives, was performed. Morphologic features were recorded, along with immunohistochemistry results when available. Electronic medical records were reviewed for clinical and radiographic information. Results.--Sixteen cases of gynecologic adenocarcinomas (9 endometrial endometrioid adenocarcinomas, 4 endometrial serous carcinomas, 2 high-grade tubo-ovarian serous carcinomas, and 1 cervical adenosquamous carcinoma) involving the bladder were identified. All included cases had mucosal involvement potentially mimicking primary bladder neoplasms, including 4 cases originally diagnosed as urinary carcinomas. Tumors expressed keratin 7 (12 of 13; 92%), PAX8 (11 of 12; 92%), estrogen receptor (11 of 15; 73%), p16 (8 of 11; 73%), progesterone receptor (8 of 14; 57%), GATA3 (5 of 12; 42%), and p63 (3 of 11; 27%); all tumors were negative for keratin 20 (0 of 12). Features supportive of Mu ¨ llerian origin included prior history of gynecologic malignancy, lack of morphologic heterogeneity in nonendometrioid tumors, and immunophenotypic coexpression of PAX8 and estrogen receptor with absent GATA3. Potential pitfalls seen in a subset of cases included misleading radiologic and cystoscopic findings, replacement of the overlying urothelial mucosa by tumor mimicking precursor lesions, focal GATA3 and/or p63 positivity, and areas of squamous differentiation in tumors of endometrioid histology. Conclusions.--A combination of clinical history, certain morphologic features, and proper selection of immunohistochemical stains is key for the correct diagnosis of secondary gynecologic adenocarcinomas involving the urinary bladder.
- Subjects
ADENOCARCINOMA; BLADDER tumors; IMMUNOPHENOTYPING; DIFFERENTIAL diagnosis; CYSTOSCOPY; OVARIAN tumors; DESCRIPTIVE statistics; RETROSPECTIVE studies; TRANSCRIPTION factors; CYTOSKELETAL proteins; FEMALE reproductive organ tumors; METASTASIS; IMMUNOHISTOCHEMISTRY; ENDOMETRIAL tumors; ESTROGEN receptors; GENE expression; MEDICAL records; ACQUISITION of data; CASE studies
- Publication
Archives of Pathology & Laboratory Medicine, 2024, Vol 148, Issue 6, p705
- ISSN
0003-9985
- Publication type
Article
- DOI
10.5858/arpa.2022-0469-OA