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Primary bladder adenocarcinoma versus metastatic colorectal adenocarcinoma: a persisting diagnostic challenge

Somak Roy1, Matthew A Smith1, Kathy M Cieply12, Marie B Acquafondata1 and Anil V Parwani13*

Author Affiliations

1 Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA

2 Florescence in-situ hybridization research and development laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA

3 Division of Pathology Informatics, Department of Pathology, 5230 Centre Avenue, Room WG 07, Pittsburgh, PA, 15232, USA

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Diagnostic Pathology 2012, 7:151  doi:10.1186/1746-1596-7-151

Published: 2 November 2012



This study attempted to distinguish primary bladder adenocarcinoma (PBA) from metastatic colonic adenocarcinomas (MCA), which is a difficult diagnostic and clinical problem.


Twenty-four cases of bladder adenocarcinomas (12 primary & 12 metastatic colorectal) were included in the study with urothelial carcinoma (UC) and colonic adenocarcinoma (CA) as controls. A panel of immunohistochemical (IHC) stains along with fluorescence in-situ hybridization (FISH), using the UroVysion probe set, was performed.


The majority of the PBAs presented with advanced disease. Enteric histologic subtype was the most common morphological variant. Strong nuclear with cytoplasmic-membranous staining of β-catenin was seen in 75% of MCA and only 16.7% PBA (<10% staining cells). Although abnormal nuclear staining with E-cadherin was seen in both PBA and MCA, it was more frequent in former. CK-7, CK-20, villin and CDX-2 stains were not helpful in distinguishing the two entities. FISH did not reveal any unique differences in chromosomal abnormality between the two groups.


Although there was a statistically significant difference in β-catenin and E-cadherin staining between two groups, we did not find any IHC or FISH marker that was specific for PBA. Distinction between PBA and MCA remains a diagnostic problem and clinical correlation is vital before rendering a diagnosis.

Virtual slides

The virtual slides for this article can be found here: webcite

Bladder; Adenocarcinoma; Primary; Metastatic; Colorectal; Beta-catenin; E-cadherin