Abstract:

Primary Adenocarcinoma of the bladder is uncommon histological variant of the transitional cell carcinoma and account 0.5% to 2.0% of all malignant vesical tumors.(1) It has an aggressive biological behavior and poor response to chemotherapy and radiotherapy. The only curative option is surgery-radical cystectomy or partial resection.(2)(4) To focus on the existence of rare histological subtype of the transitional cell carcinoma of the urinary bladder and to differ the primary from the secondary “  metastatic  ” adenocarcinoma. A 73 years old male with gross hematuria, anemia and renal failure.  Ultrasound and CT reveal solid, infiltrative tumor in the trigone with engagement to the left ureteric orifice and ureterohydronephrosis. histologic and immunohistochemical examination of the resected specimen showed primary bladder adenocarcinoma. No radical surgical treatment was performed because of the comorbidity and deteriorated general condition of the patient. We managed percutaneous nephrostomy with chemotherapy and radiotherapy. The malignant degeneration of the urothelium into the rare histological variant “ adenocarcinoma”arises many  questions. It is accepted that predisposition for adenocarcinoma exist in patients with bladder extrophy, in areas where infection with Schistosoma is endemic, chronic urine retention, cystitis(3) More common is the secondary “ metastatic” adenocarcinoma  from the digestive system and the genital system. This requires detailed clinical investigation of the patients and histologic and immunohistochemical examination of the resected tumor.(5),(6) A number of secondary "metastatic" adenocarcinomas are described such as urachus carcinoma, ring-cell carcinoma, hepatoid adenocarcinoma; metastatic prostate adenocarcinoma and mixed tumors.(7) Despite the scarcely information on rare histological variants of urothelial carcinoma of the urinary Bladder, there is sufficient evidence based on worldwide practice supporting the fact that histological and immunohistochemical subtyping of the tumor is essential in therapeutic and prognostic terms. Primary adenocarcinoma of the bladder is a rare neoplasia of the urothelium with aggressive biological behavior. Tumor is usually manifested in an advanced clinical stage. This limits surgical treatment options in partial resection or radical cystectomy with adjuvant chemotherapy or radiotherapy.  

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