Multicystic urothelial carcinoma of the bladder with gland-like lumina and with signet-ring cells. A case report

Urothelial carcinomas, particularly high-grade tumors, may show divergent differentiation. Urothelial carcinomas with true glandular differentiation must be distinguished from urothelial carcinomas with gland-like lumina. The latter represents microcystic change within otherwise typical urothelial carcinoma. Although these spaces may contain mucin, they differ from urothelial carcinoma admixed with a well-defined adenocarcinoma component [1].Glandular neoplasms arising in the urinary bladder are an uncommon but generally recognized category of tumors. Approximately 2% of primary carcinomas in this organ account for non urachal adenocarcinomas with or without mucus production, including signet ring cell carcinomas [2,3]. We present a case of low-grade papillary urothelial carcinoma characterized by striking degrees of glandular differentiation, microcystic change and signet ring cell morphology.An 80-year-old male, a heavy smoker, was admitted to the hospital due to hematuria. Cystoscopy revealed multiple superficial small tumors ranged in size from 0.4–2 cm. Transurethral resection was performed and subsequent local chemotherapy by Mitomycin followed. The patient underwent cystoscopic resection of three recidiving superficial tumors 1 year later. The patient was alive and well without sign of disease 3 years after the second surgery.The primary tumor was characterized by multicystic and papillary architecture and the presence of gland formation (Figure 1). Cysts were lined with urothelial cells. Some areas had columns of cells arranged concentrically around eosinophilic PAS (periodic acid shiff)-positive material-filled gland spaces (Figure 2). Additionally, numerous signet-ring cells were present in some parts (Figure 3). Areas with gland-like lumina formation were also noted. Morphology of recidiving tumor was identical to that of the primary lesion.Tissue for light microscopy was fixed in 4% formaldehyde and embedded in paraffin using routine procedure. Sections