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Case 98 Answer

 

Diagnosis:
Mixed Bladder Adenocarcinoma with Transitional Carcinoma.

Discussion

This specimen is showing a high-grade invasive tumor, not involving the muscularis propria of the bladder. The tumor shows solid areas that appear transitional in appearance, mixed with obvious areas of Adenocarcinoma.

The glandular component appears to be in situ and invasive. In situ superficial areas of adenocarcinoma show frequent goblet cells. There are also areas of transitional carcinoma in situ adjacent to the tumor.  Both the glandular and solid areas of the tumor are positive for EMA, CDX2, CK7, CK20, GATA3 and uroplakin.  Villin 3 is only positive in the glandular component. B catenin is positive in tumoral cells, only membranous positivity.

Arguing against the possibility of a metastatic colonic  Adenoca are the history of endoscopic and radiologic absence of intestinal lesion, the intense positivity of CK7, the nuclear negativity for B catenin in the tumoral cells (only membranous positivity) and the positivity for uroplakin.  Colon adenocarcinoma frequently shows nuclear B catenin and is negative for CK7, GATA3 and uroplakin.  GATA3 is a marker positive in tumors of breast origin or mullerian origin like bladder.  Villin may be positive in a percentage of bladder adenocarcinomas and also CDX2 may be focally positive in bladder adenocarcinomas.