NH MDT Medicine class of 22 - presentation

Health

1. M. J. C. Pathology , Lancet Prof. Lucy Muchiri

2. Clinical Information Name: Mukami , Jean Charity Gender: Female Age: 75y Specimen: Received 25/01/2022 Multiple fragments

3. Microscopy Multiple fragments showing an ulcerated largely necrotic poorly differentiated carcinoma Areas of viable tumor show what may be glandular differentiation Tumor composed of markedly pleomorphic cells arranged nests and trabeculae exhibiting marked Hyperchromasia & nuclear pleomorphism Mitotic figures Mild desmoplastic reaction around tumor and intense inflammatory infiltrate

4. Conclusion: Poorly differentiated carcinoma favor glandular differentiation

5. Bladder Adenocarcinoma Epidemiology Rare primary neoplasm, 0.5 - 2% of bladder malignancies ( J Urol 2010;183:915 ) 0.7% of upper urinary tract tumors ( Clin Genitourin Cancer 2021;19:117 ) M:F = 3:1 Mean age 68 years ( J Urol 2010;183:915 ,  Cancer 1991;67:2165 ) Sites Usually lateral, posterior wall or trigone of bladder (if dome, should consider urachal adenocarcinoma by default)

6. Gross appearance of Bladder carcinoma

7. Microscopic (histologic) types Microscopic (histologic) description Intestinal type (or enteric type): Resembles colonic adenocarcinoma ( Cancer 1991;67:2165 ) Neoplastic glands are lined by pleomorphic mucin producing pseudostratified columnar epithelium Central dirty necrosis is commonly seen Mucinous (colloid) type: Nests of neoplastic cells floating in abundant extravasated mucin Singly dispersed or groups of signet ring cells can be seen in the mucin pools Mucin usually deeply invades muscularis propria Signet ring cell type (diffuse poorly differentiated adenocarcinoma): Discohesive round cells with large intracellular mucin vacuoles displacing nuclei to the periphery without extracellular mucin Diffusely infiltrating stromal tissue Association with in situ component is an important clue to differentiate primary adenocarcinoma of the bladder from secondary adenocarcinoma involving the bladder

8. An example of a poorly differentiated adenocarcinoma with desmoplastic reaction