2020-27 / July 06
(Contributor: Daniel Athanazio)

A man in his late 80s underwent a transurethral resection of the bladder due to clinical diagnosis of bladder cancer.


1. What is the diagnosis?

a. Bladder adenocarcinoma

b. Bladder villous adenoma

c. Prostate adenocarcinoma

d. Florid cystitis glandularis and invasive adenocarcinoma

e. Urothelial carcinoma (high grade papillary, in situ and invasive) with glandular differentiation

1. Urothelial carcinoma (high grade papillary, in situ and invasive) with glandular differentiation

Divergent differentiation is common in invasive urothelial carcinoma and may be clinically relevant. Divergent morphology in non-invasive urothelial neoplasia (both papillary and flat / in situ) is described, however, no prognostic value is established for this finding. About 50% of patients with non-invasive urothelial carcinoma with glandular differentiation eventually develop invasive cancer which can be of urothelial or small cell morphology. In a series reported by Miller and Epstein (2009), none of 18 patients with available follow up developed invasive adenocarcinoma. In a more recent series of 92 cases of urothelial carcinoma in situ with glandular differentiation reported by Yang and Epstein (2018), 65 (70%) had concurrent invasive carcinoma and 13/65 (20%) of them showed glandular differentiation – as in the present case.

The diagnosis of glandular differentiation in non-invasive urothelial carcinoma must exclude the differential diagnoses of non-invasive papillary urothelial carcinoma with micropapillary morphology or gland-like cystic spaces lined by urothelial cell and not true glandular/columnar cells.

Yang Z, Epstein JI. Urothelial Carcinoma In Situ of the Bladder With Glandular Differentiation: Report of 92 Cases. Am J Surg Pathol. 2018 Jul;42(7):971-976.
Miller JS, Epstein JI. Noninvasive urothelial carcinoma of the bladder with glandular differentiation: report of 24 cases. Am J Surg Pathol. 2009 Aug;33(8):1241-8.

Daniel Athanazio
Federal University of Bahia
Imagepat, Laboratory of Pathology
Salvador, Bahia, Brazil


Bladder; urothelial carcinoma; divergent differentiation