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01-02-2013 | Original Article

Histology and immunohistochemistry of clear cell adenocarcinoma of the urethra: histogenesis and diagnostic problems

Authors: Borislav A. Alexiev, Fabio Tavora

Published in: Virchows Archiv | Issue 2/2013

Abstract

Clear cell adenocarcinoma (CCAC) of the urethra is a rare neoplasm, morphologically identical to its homologue arising in the female genital tract. The histogenesis of this neoplasm is uncertain. We present clinical, histopathologic, and immunohistochemical findings of four CCAC of the urethra and discuss the histogenesis and difficulties in diagnosis and differential diagnosis. CCAC of the urethra occurred in females (4/4). Two neoplasms were identified in urethral diverticulum; one of the two cases, in close proximity to a nephrogenic adenoma. CCAC exhibited tubulocystic, papillary, and diffuse/solid growth patterns. The neoplastic cells were cuboidal or columnar with eosinophilic or clear cytoplasm, and nuclear pleomorphism of at least moderate degree. Hobnail features and tumor necrosis were also observed. CCAC expressed p53 (4/4), AMACR (3/4), vimentin (3/4), PAX8 (2/4), CK7 (2/4), cytokeratin 34betaE12 (2/4), RCC (1/4), and CK20 (1/4) and were negative for PSA, WT1, ER, CA 125, uroplakin III, p16, and p63. The immunohistochemical profile supports a possible renal tubular cell differentiation/mesonephric origin for some urethral CCAC. Nephrogenic adenoma and metastatic clear cell carcinoma are the most important differential diagnostic considerations. Multicenter studies on more cases may improve our understanding of this malignancy.

Tanabe ET, Mazur MT, Schaeffer AJ (1982) Clear cell adenocarcinoma of the female urethra: clinical and ultrastructural study suggesting a unique neoplasm. Cancer 49:372–378PubMedCrossRef

Young RH, Scully RE (1985) Clear cell adenocarcinoma of the bladder and urethra. A report of three cases and review of the literature. Am J Surg Pathol 9:816–826PubMedCrossRef

Oliva E, Young RH (1996) Clear cell adenocarcinoma of the urethra: a clinicopathologic analysis of 19 cases. Mod Pathol 9:513–520PubMed

Oliva E, Amin MB, Jimenez R, Young RH (2002) Clear cell carcinoma of the urinary bladder. A report and comparison of four tumors of Müllerian origin and nine of probable urothelial origin with discussion of histogenesis and diagnostic problems. Am J Surg Pathol 26:190–197PubMedCrossRef

Herawi M, Drew PA, Pan CC, Epstein JI (2010) Clear cell adenocarcinoma of the bladder and urethra: cases diffusely mimicking nephrogenic adenoma. Hum Pathol 41:594–601PubMedCrossRef

Hull MT, Eglen DE, Davis T, Glant MD, Eble JN (1987) Glycogen-rich clear cell carcinoma of the urethra: an ultrastructural study. Ultrastruct Pathol 11:421–427PubMedCrossRef

Drew PA, Murphy WM, Civantos F, Speights VO (1996) The histogenesis of clear cell carcinoma of the lower urinary tract. Case series and review of the literature. Hum Pathol 27:248–252PubMedCrossRef

Rivard DJ, Waisman SS (1985) Primary mesonephric carcinoma of the female urethra. J Urol 134:756–757PubMed

Murayama T, Komatsu H, Asano M, Tahara M, Nakamura T (1978) Mesonephric adenocarcinoma of the urethra in a woman: report of a case. J Urol 120:500–501PubMed

10.

Konnak JW (1973) Mesonephric carcinoma involving the urethra. J Urol 110:76–78PubMed

11.

Spencer JR, Brodin AG, Ignatoff JM (1990) Clear cell adenocarcinoma of the urethra: evidence for origin within paraurethral ducts. J Urol 143:122–125PubMed

12.

Tong GX, Weeden EM, Hamele-Bena D, Huan Y, Unger P, Memeo L, O’Toole K (2008) Expression of PAX8 in nephrogenic adenoma and clear cell adenocarcinoma of the lower urinary tract: evidence of related histogenesis? Am J Surg Pathol 32:1380–1387PubMedCrossRef

13.

Signori G, Tonini G, Auleti V, Taher B, Rad FK, Tosana M, Ungari M, Zorzi F (2003) Clear cell adenocarcinoma of the bladder in a male patient: clinicopathologic analysis of a case. Urol Int 71:228–230PubMedCrossRef

14.

Balat O, Kudelka AP, Edwards CL, Silva E, Kavanagh JJ (1996) Malignant transformation in endometriosis of the urinary bladder: case report of clear cell adenocarcinoma. Eur J Gynaecol Oncol 17:13–16PubMed

15.

Adeniran AJ, Tamboli P (2009) Clear cell adenocarcinoma of the urinary bladder; a short review. Arch Pathol Lab Med 133:987–991PubMed

16.

Moinzadeh A, Latini J, Hamawy KJ (2003) Clear cell adenocarcinoma of the urinary bladder within a diverticulum. Urology 62:145PubMedCrossRef

17.

Suttmann H, Holl-Ulrich K, Peter M, Kausch I, Doehn C, Jocham D (2006) Mesonephroid adenocarcinoma arising from mesonephroid metaplasia of the urinary bladder. Urology 67(846):e7–e8PubMed

18.

Seseke F, Zöller G, Kunze E (2001) Clear cell adenocarcinoma of the male urethra in association with so-called nephrogenic metaplasia. Urol Int 67:104–108PubMedCrossRef

19.

Mai KT, Yazdi HM, Perkins DG, Morash C, Green J (2000) Multicentric clear adenocarcinoma in the urinary bladder and the urethral diverticulum: evidence of origin of clear cell adenocarcinoma of the female lower urinary tract from Müllerian duct remnants. Histopathology 36:380–382PubMedCrossRef

20.

Gilcrease MZ, Delgado R, Vuitch F, Albores-Saavedra J (1998) Clear cell adenocarcinoma and nephrogenic adenoma of the urethra and urinary bladder: a histopathologic and immunohistochemical comparison. Hum Pathol 29:1451–1456PubMedCrossRef

21.

Eble JN, Sauter G, Epstein JI, Sesterhenn IA (eds) (2004) World Health Organisation Classification of Tumours. Pathology and genetics of tumors of the urinary system and male genital organs. IARC Press, Lyon

22.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York, NY

23.

Kösem M, Sengül E (2005) Clear cell adenocarcinoma of the urinary bladder. Scand J Urol Nephrol 39:89–92PubMedCrossRef

24.

Caplan J, Hartman M, Rooker G (2011) Adenocarcinoma of the female urethra: clear cell variant. Radiol Case Rep 6:1–3

25.

Amin MB, Young RH (1997) Primary carcinomas of the urethra. Sem Diagn Pathol 14:147–160

26.

Swartz MA, Porter MP, Lin DW, Weiss NS (2006) Incidence of primary urethral carcinoma in the United States. Urology 68:1164–1168PubMedCrossRef

27.

Ingram EA, DePauw P (1985) Adenocarcinoma of the male urethra with associated nephrogenic metaplasia. Case report and review of the literature. Cancer 55:160–164PubMedCrossRef

28.

Hartmann A, Junker K, Dietmaier W, Schröder S, Lopez D, Hofstädter F, Blaszyk H (2006) Molecular evidence for progression of nephrogenic metaplasia of the urinary bladder to clear cell adenocarcinoma. Hum Pathol 37:117–120PubMedCrossRef

29.

Sung MT, Zhang S, MacLennan GT, Lopez-Beltran A, Montironi R, Wang M, Tan PH, Cheng L (2008) Histogenesis of clear cell adenocarcinoma in the urinary tract: evidence of urothelial origin. Clin Cancer Res 14:1947–1955PubMedCrossRef

30.

Reid-Nicholson MD, Motiwala N, Drury SC, Peiper SC, Terris MK, Waller JL, Ramalingam P (2011) Chromosomal abnormalities in renal cell carcinoma variants detected by Urovysion fluorescence in situ hybridization on paraffin-embedded tissue. Ann Diagn Pathol 15:37–45PubMedCrossRef

31.

Brimo F, Herawi M, Sharma R, Netto GJ, Epstein JI, Illei PB (2011) Hepatocyte nuclear factor-1β expression in clear cell adenocarcinomas of the bladder and urethra: diagnostic utility and implications for histogenesis. Hum Pathol 42:1613–1619PubMedCrossRef

32.

Bagby CM, MacLennan GT (2008) Clear cell adenocarcinoma of the bladder and urethra. J Urol 180:2656PubMedCrossRef

Title: Histology and immunohistochemistry of clear cell adenocarcinoma of the urethra: histogenesis and diagnostic problems
Authors: Borislav A. Alexiev
Fabio Tavora
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Virchows Archiv / Issue 2/2013
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-012-1363-3

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Springer Medicine

Histology and immunohistochemistry of clear cell adenocarcinoma of the urethra: histogenesis and diagnostic problems

Abstract

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