An autopsy case of clear cell adenocarcinoma of the urinary bladder

Clear cell adenocarcinoma of the urinary bladder is rare. A 73-year-old woman presented with chronic renal and cardiac failure. Blood tests showed elevated carcinoembryonic antigen and CA19-9 levels. Imaging techniques showed bilateral hydronephrosis and hydroureter. Cystoscopy showed a bladder tumor, and the biopsy showed malignant cells. The patient died 4 months later. Autopsy showed an elevated tumor of the bladder. Metastases to the liver, lungs, adrenal glands, spleen and bones were observed. The kidney showed chronic active pyelonephritis with hydronephrosis. The cause of death was chronic renal and cardiac failure and/or carcinomatosis. Histologically, the bladder tumor consisted of malignant clear cells arranged in solid nests and tubules. Histochemical stains for glycogen and mucins were negative. Metastases also showed similar histology. Immunohistochemically, the tumor cells were positive for carcinoembryonic antigen, CA19-9, CA125, CD10, pancytokeratins (AE1/3, CAM5.2), cytokeratin (CK) 34βE12, CK7, CK8, CK18, CK19, EMA, MUC1, p53, and Ki-67 (labeling=40%). They were negative for CK5/6, CK14, CK20, estrogen receptor, progesterone receptor, α-methylacyl-CoA-racemase, p63, CDX2, MUC2, MUC5AC, MUC6, CD45, CD34, vimentin, neuron-specific enolase, S100 protein, desmin, HMB45, AFP, α-smooth muscle actin, MDM2, HER2/neu, synaptophysin, and CD56. Metastases showed the same immunohistochemical findings.