Diagnosi: Bladder metastasis of renal clear cell carcinoma.

Notes: The renal clear cell carcinoma can metastasise to the bladder and the cases in the literature are only a few.
The differential diagnosis of the clear cell tumors in the bladder includes both benign and malignant tumor, either primary or metastatic.
Between the benign diseases one should consider the nephrogenic adenoma, in particular on the biopsies and the material from the TUR.
The transitional cell carcinoma with glandular differentiation, the clear cell carcinoma of mullerian origin and the intestinal type bladder carcinoma of urachal origin should be consider in the differential diagnosis with metastatic clear cell tumors.
The metastatic tumor in the urinary bladder are mainly due to direct extension from adjacent organs as prostate, uterine cervix, rectum; those due to metastatic spread are rarer.
The alveolar growth with a fine vascular net and with tall, columnar cells contrasts morphologically with the tubular, cystic and papillary, growth and the presence of the “Hobnail cells” which is typical of the mullerian clear cells tumors.
Normal or neoplastic urothelium is usually present in the urothelial carcinoma with glandular differentiation, as well as the intestinal differentiation combines with the urachal adenocarcinoma.
From the immunohistochemical point of view the bladder clear cell carcinoma is CK7 and CK20 positive while the kidney clear cell carcinoma is negative for those and positive for CAM5.2 and Vimentin.






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