Primary mucinous adenocarcinoma in a defunctionalized urinary bladder: a case report

We report a 57-year-old Caucasian man presenting with penile discharge for 30 years following ileal conduit surgery for neurogenic bladder, and who was found to have primary mucinous adenocarcinoma of his defunctionalized bladder.Although urinary diversion without cystectomy is less common in current urologic practice, there are many patients with longstanding defunctionalized bladders. While there are no established surveillance protocols, defunctionalized bladder patients with urethral discharge should be evaluated.Primary adenocarcinoma of the urinary bladder accounts for approximately 0.5-2% of all bladder cancers [1]. Patients generally present with hematuria, dysuria, suprapubic pain, and, less commonly, mucusuria. The histologic appearance of bladder adenocarcinoma can be enteric, signet ring, mucinous, clear cell, hepatoid and mixed types. The differential diagnosis includes glandular differentiation of transitional cell carcinoma and direct extension or metastatic spread of adenocarcinoma arising primarily from the colon, prostate, appendix or endometrium.Predisposing factors for the development of primary adenocarcinoma of the bladder include schistosomiasis, exstrophy, persistent urachal remnants, and bladder augmentation by intestinal segments [1,2]. Concomitant cystitis glandularis occurs in the majority of cases, but is not considered a definitive precursor lesion since adenocarcinoma can develop in the absence of cystitis glandularis and only a small number of bladders with cystitis glandularis actually develop malignancies [2].The potential for adenocarcinoma to develop in the defunctionalized bladder that is left in-situ at the time of urinary diversion is rare [3-5]. We describe the fifth case of primary mucinous adenocarcinoma arising in a longstanding defunctionalized bladder.A 57-year-old Caucasian man presented with profuse blood-streaked mucous drainage from his penis. Past medical history was significant for T12 spinal cord injury secondary t