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Presented by Dr. Andres Matoso and prepared by Dr. Sintawat Wangsiricharoen.
A 34-year-old male with urethral obstruction.
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Question 1 of 1
1. Question
A 34-year-old male with urethral obstruction.
Correct
Correct: B
Histology: There are small atypical glands infiltrating the soft tissue around the Cowper’s glands. These glands focally show solid and cribriform morphology and there are multiple foci of perineural invasion. Tumor cells have large nuclei and prominent nucleoli and the nuclei protrude into the glandular lumina with a hobnail appearance. The intraluminal space has a myxoid material.
Discussion: Clear cell adenocarcinoma is very rare in the genitourinary tract of men. The usually present in the periurethral area, utricle or bladder. When the tumor is small and does not display clear signs of malignancy, the main differential diagnosis is with nephrogenic adenoma. Both clear cell adenocarcinoma and nephrogenic adenoma have the same immunophenotype, both are positive broad spectrum cytokeratins, PAX8, and napsin. Clear cells adenocarcinoma is also frequently positive for HNF1b and display a high Ki67 proliferation rate, which can be used in difficult cases to differentiate it from nephrogenic adenoma. The treatment is surgical with a potential role for radiotherapy and or chemotherapy in recurrence or unresectable cases. The prognosis is variable.
Reference:
Virchows Arch. 2019 Dec;475(6):727-734.Incorrect
Correct: B
Histology: There are small atypical glands infiltrating the soft tissue around the Cowper’s glands. These glands focally show solid and cribriform morphology and there are multiple foci of perineural invasion. Tumor cells have large nuclei and prominent nucleoli and the nuclei protrude into the glandular lumina with a hobnail appearance. The intraluminal space has a myxoid material.
Discussion: Clear cell adenocarcinoma is very rare in the genitourinary tract of men. The usually present in the periurethral area, utricle or bladder. When the tumor is small and does not display clear signs of malignancy, the main differential diagnosis is with nephrogenic adenoma. Both clear cell adenocarcinoma and nephrogenic adenoma have the same immunophenotype, both are positive broad spectrum cytokeratins, PAX8, and napsin. Clear cells adenocarcinoma is also frequently positive for HNF1b and display a high Ki67 proliferation rate, which can be used in difficult cases to differentiate it from nephrogenic adenoma. The treatment is surgical with a potential role for radiotherapy and or chemotherapy in recurrence or unresectable cases. The prognosis is variable.
Reference:
Virchows Arch. 2019 Dec;475(6):727-734.
