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Pathology for Urologists

Urachal Adenocarcinoma

Image A
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Image B
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  • Diagnostic criteria:
    • Tumor located at bladder dome (mostly) or anterior wall.
    • Tumor epicenter in bladder wall.
    • Absence of florid cystitis glandularis in bladder surface (exclude precursor lesions of primary bladder adenocarcinoma)
    • Absence of know primary adenocarcinoma of same morphology elsewhere.
  • Histology:
    • More often the tumor has the appearance of a mucinous ("colloid") carcinoma (tumor cells floating in a sea of mucin) (image A), (image B), (image C), & (image D).
    • May also have enteric morphology (looks like colorectal adenocarcinoma).
    • Other morphologies include signet ring cell, which can diffusely spread into the bladder, and adenocarcinoma, not otherwise classifiable, or a mixed of these different patterns.

Image C
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Image D
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  • Similar immunohistochemical staining (CDX2+, CK7+ and β-catenin-) with urachal adenocarcinoma.
  • Treated by en bloc resection of bladder, urachal remnant, and umbilicus.
  • Staging is different from bladder urothelial carcinoma.
  • Poor survival, reported 5-year survival at 25-61%.


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