Villous Adenoma Coexisting with Non-Muscle Invasive Urothelial Carcinoma of the Bladder, Case Report

A 72-year old patient was admitted to hospital with the complaint of non-coagulated hematuria and pain. There was no remarkable finding in physical examination. Cystoscopic examination revealed two papillary tumors in the urinary bladder. Larger one measuring 25 mm was on the dome of bladder and the other was 16 mm mass in the left wall of urinary bladder, with enhancement. Cold punch biopsy was performed at cystoscopic examination. Histopathology confirmed that the resected one tumor was a villous adenoma, and the other was non-muscle invasive urothelial carcinoma. TUR was performed after punch biopsy. Each tumor was resected and diagnosed, respectively. Histopathology confirmed that the mass was a villous adenoma with a polypoid growth of the glandular epithelium consisting of small tubular glands, dilated cystic glands or papillary fronds lined by a columnar epithelium and including goblet cells. Intracellular and extracellular mucin was seen. Epithelial cells displayed mild nuclear atypia and nuclear pseudostratification suggestive of severe dysplasia. No invasive component was found in the villous adenoma (Figure 1). Immunohistochemical analysis of the polypoid lesion showed that the epithelial cells were diffusely positive for cytokeratin 20 (CK20), focally positive for cytokeratin 7 (CK7), carcinoembryonic antigen (CEA) and mucin 2 (MUC2). Non-muscle invazive urothelial carcinoma was identified the other side of urinary bladder (Figure 2). Based on the pathological findings, the patient was diagnosed with a rare case of villous adenoma of the bladder and non-muscle infiltrative urothelial carcinoma arising in the bladder. After BCG therapy, he has been followed by cystoscopic examination for every three months. Over the past 29 months of follow up no local recurrences were detected. 1Akdeniz University Faculty of Medicine, Department of Pathology, Antalya, Turkey 2Başkent University Faculty of Medicine, Department of Pathology, Antalya, Turkey 3Akdeniz University Faculty of Medicine, Department of Urology, Antalya, Turkey Bahar Akkaya MD1, Gülden Tasova-Yılmaz MD1, Hampar Akkaya MD2, Mustafa Faruk Usta MD3 Kas İnvazyonu Göstermeyen İnvaziv Ürotelial Karsinomla Birlikte Görülen Mesanenin Villöz Adenomu, Olgu Sunumu Villous Adenoma Coexisting with Non-Muscle Invasive Urothelial Carcinoma of the Bladder, Case Report