Vesical (bladder) clear cell adenocarcinoma arising from endometriosis: A mullerian tumor, indistinguishable from ovarian clear cell adenocarcinoma Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Saturday, September 24, 2016

Vesical (bladder) clear cell adenocarcinoma arising from endometriosis: A mullerian tumor, indistinguishable from ovarian clear cell adenocarcinoma




ve·si·cal
ˈvesəkəl/adjective AnatomyMedicine
adjective: vesical of, relating to, or affecting the urinary bladder.
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open access:
Vesical clear cell adenocarcinoma arising from endometriosis: A mullerian tumor, indistinguishable from ovarian clear cell adenocarcinoma

Case Report.
A 44-year-old para 0, with a history of urge urinary incontinence and recurrent urinary tract infections, presented with urinary frequency, incontinence, and hematuria. In 2008, she was diagnosed with urge incontinence and treated with tolterodine with improvement in symptoms. Multiple urinalyses at that time were positive for blood. The patient was lost to follow up until 2015, when she re-presented with recurrent symptoms. A urinalysis revealed many red blood cells and multiple urine cultures were negative.....The immunoprofile itself could not distinguish primary bladder clear cell adenocarcinoma from metastatic clear cell adenocarcinoma from the gynecologic tract.

  • Malignant transformation of extra-ovarian endometriosis is rare
  • Histology and immunohistochemistry support mullerian origin of this malignancy
  • Consideration can be given to extrapolating treatment from gynecologic literature

Abstract

Endometriosis is associated with increased rates of ovarian, particularly clear cell, adenocarcinomas. Malignant transformation of ovarian endometriosis is most common but rare cases have been reported in the bladder, abdominal wall, diaphragm, and rectum. We present the case of a 44-year-old female with vesical clear cell adenocarcinoma arising in a background of endometriosis in the absence of other pelvic endometriosis. The malignancy was diagnosed on transurethral resection of bladder tumor and managed with radical surgery. Histology and immunohistochemical findings were consistent mullerian origin and indistinguishable from similar tumors arising in the female genital tract. Extrapolating from the gynecologic literature, the recommendation was made for adjuvant chemotherapy. Further studies are needed to clarify the optimal treatment paradigm for ovarian and bladder clear cell adenocarcinomas.


Endometriosis, the presence of endometrial glands and stroma at extra-uterine sites, is common among reproductive age women, prevalence ranging 3–15% (Kim et al., 2014). The etiology of endometriosis is unknown but proposed mechanisms include retrograde menstruation, hematogenous or lymphatic dissemination, and coelomic metaplasia. Endometriosis is most frequently identified on the ovaries, rectovaginal septum, and broad and uterosacral ligaments (Loizzi et al., 2015). Endometriosis may also involve extra-pelvic organs including the small and large intestine, abdominal scars, the urinary system, and the lung/diaphragm. The bladder is the most common site of occurrence within the urinary system, though it is involved in less than 1% of extra-ovarian cases (Dadhania et al., 2015, Mann et al., 2012)....

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