Urachal and Non-urachal Adenocarcinomas of the Bladder

Abstract

Pure adenocarcinomas of the bladder are a very rare entity. It is important to understand the distinctions between the different types of adenocarcinomas that may be found in the bladder, as it may have an impact on their treatment. Urachal carcinomas, traditionally found in the midline or dome of the bladder, require a surgical procedure that is different from the typical cystectomy. Metastatic adenocarcinomas can occur from direct extension of local organs including the colon and rectum, from drop implants/peritoneal seeding from other adenocarcinomas of the abdominal cavity, and even from hematogenous metastases from primary sites both within and outside the abdominal cavity. Often, a careful medical history of previous cancer, clinical symptoms which are not typically associated with a bladder primary, and radiological findings suggestive of other potential primaries can aid in diagnosing a metastasis to the bladder. Adenocarcinomas of the urethra, which are addressed in a separate chapter, can also invade the bladder base and trigone secondarily. Only when none of these above findings are present should one consider the patient a true primary adenocarcinoma of the bladder.