Bladder & urothelial tract
Glandular neoplasms
Adenocarcinoma in situ
Author: Rugvedita Parakh, M.D.
Last author update: 1 December 2014
Last staff update: 9 May 2023
Copyright: 2003-2025, PathologyOutlines.com, Inc.
PubMed Search: Adenocarcinoma in situ [title] bladder
Table of Contents
Definition / general | Terminology | Clinical features | Treatment | Gross description | Microscopic (histologic) description | Differential diagnosisCite this page: Parakh R. Adenocarcinoma in situ. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladderadenoinsitu.html. Accessed April 1st, 2025.
Definition / general
- Primary noninvasive adenocarcinoma of bladder
- Findings below are for patients without concurrent invasive adenocarcinoma or villous adenoma
Terminology
- Also called noninvasive urothelial carcinoma with glandular differentiation (Am J Surg Pathol 2009;33:1241)
Clinical features
- Mean age 70 years, 75% male
- Associated with urothelial CIS or papillary urothelial carcinoma without invasion
- 50-74%% developed invasive carcinoma, including high incidence of poorly differentiated, micropapillary and small cell urothelial carcinoma (Am J Surg Pathol 2001;25:892)
Treatment
- Transurethral excision; intravesical chemotherapy; intravesical bCG
Gross description
- Exophytic, papillary to flat
Microscopic (histologic) description
- Papillary, flat, and cribriform architecture
- Neoplastic cells are columnar with luminal cytoplasm with occasional intracytoplasmic mucin
- True glandular differentiation (by definition)
- Moderate to severe nuclear pleomorphism, apoptosis, 5+ mitotic figures/10 HPF
- Noninvasive, by definition
- Often associated with other urothelial carcinoma patterns including small cell, micropapillary and poorly differentiated
- Rare necrosis
- Not commonly associated with invasive adenocarcinoma
Differential diagnosis
- Urothelial carcinoma in situ: no invasion, no glandular formation, no/rare intracytoplasmic mucin
- Urothelial carcinoma with gland like spaces: invasive, no true glandular formation, no/rare intracytoplasmic mucin
- Florid cystitis glandularis with or without intestinal metaplasia: insufficient atypia to diagnosis as carcinoma in situ
- Villous adenoma: insufficient atypia to diagnosis as carcinoma in situ
- Noninvasive micropapillary carcinoma: has characteristic retraction-like spaces; no glandular formation, no/rare intracytoplasmic mucin
- Clear cell adenocarcinoma: invasive, hobnail cells
