Primary adenocarcinoma of the urinary bladder. A clinicopathologic and prognostic study.

The study is a clinicopathologic report on 64 patients with primary adenocarcinoma of the urinary bladder and urachus, with particular reference to important prognostic and therapeutic factors. All tumors exhibited adenocarcinomatous features in at least two thirds of the examined tumor area. Pure forms of the different histological patterns were seen in 50% of the cases and in the remaining tumors a mixture was recorded. Poorly differentiated tumors were found in 41 cases. All tumors were invasive and in 40 cases the tumors penetrated through the bladder wall. The pattern and frequency of metastasis was similar to that of conventional bladder tumors of high stage. The prognosis for patients with primary adenocarcinoma of the bladder was poor and the 5-year survival rate in this study was 18%. Important prognostic factors were tumor stage, size and grade and treatment. The location of the tumor seemed less important and tumors located in the dome or anterior wall did not indicate a poorer prognosis. The adenocarcinomas of the urinary bladder were predominantly solitary tumors. They were poorly differentiated, deeply invasive large tumors associated with an exceedingly poor prognosis. Partial bladder resection appears to be adequate therapy only in patients with moderately well differentiated small tumors. In other cases more radical therapy must be considered.