A Rare Case of Primary Clear Cell Adenocarcinoma of the Urinary Bladder

Abstract

Adenocarcinoma is a rare form of urinary bladder cancer, comprising only 2% of cases, with various histological patterns and levels of differentiation. Among these, clear cell adenocarcinoma is the least common. Contrary to other subtypes, clear cell adenocarcinoma of the bladder has been shown to have a female predominance, and typically presents at the age of 60 after being incidentally discovered on radiological and urinary studies. However, signs and symptoms such as visible and non-visible hematuria, and signs and symptoms of urinary tract infection refractory to antibiotic treatment could occur and clue into the diagnosis. Although imaging can reveal and characterise the lesion, definitive diagnosis requires cystoscopy with biopsy. The treatment of adenocarcinoma of the bladder often requires surgical resection, with adjuvant chemotherapy being utilized in a subset of patients. We report a 79-year-old patient complaining of gross hematuria. Ultrasound was performed and showed a calcified mass at the dome of the urinary bladder, which was confirmed by computerized tomography of the abdomen and pelvis. Subsequent cystoscopy confirmed the diagnosis of clear-cell adenocarcinoma and the tumor was resected using a trans-urethral approach. Radical cystectomy with regional lymphadenectomy and adjuvant chemotherapy were used as the primary therapeutic modality.