Case Study: Mucinous Adenocarcinoma of the Bladder

Rafay Khan and associates from the Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, USA recently reported an interesting case of a young adult with no clear risk factors who was diagnosed with a rare case of mucinous adenocarcinoma of the bladder. The study is published in the Oncology Letters.

Background

Bladder cancer is one of the most common forms of malignancies involving the urinary system and multiple risk factors have been associated with its etiology. The most common of which include:

• Cigarette smoking
• Various occupational or chemical exposures

It is usually diagnosed in older individuals with an average age of 70. In rare cases, it is observed in children as well as young adults where it usually presents as a low grade, non-invasive disease.

Case Presentation

The authors studied a 27-year-old male patient who presented with no significant risk factors and was treated for mucinous adenocarcinoma of the bladder while further investigations were performed to identify other associated factors related to this form of malignancy.

Following diagnosis, cystoscopy with transurethral resection of bladder tumor was performed with insertion of a right ureteral stent and bladder biopsies were taken. However, complete resection of the tumor was not possible due to the extensive nature of the tumor. Following dome-biopsy, a diagnosis was made of urachal primary mucinous adenocarcinoma with prominent signet ring features and extension into the subepithelial connective tissues. The tumor was staged at pT1.

Discussion

The authors discussed that the patient presented with painless hematuria, which is the most common symptom, however, the patient's history did not demonstrate a clear correlation with any significant risk factor that may suggest the emergence of bladder cancer.

Although the oncogenesis of urothelial tumors in young patients is unclear, multiple environmental and genetic factors may contribute to the etiology. The amount of tobacco smoking and certain occupation exposure have been documented to be known risk factors for urothelial tumors. The causes of bladder cancer in the young age group, however, have not been well reported in the literature. Furthermore, further research should determine whether a young patient diagnosed with bladder cancer with tumor markers may necessitate early colonoscopy screening.

Conclusion

Hence, they concluded that "a patient under the age of 30 with no past medical history, a non-smoker, and little exposure in the work space presenting with such symptoms demonstrates the unclear etiologies of this form of malignancy, which are yet to be fully studied and brings into question whether there is any association with bladder cancer and the development of other cancers."