Urinary cytologic findings of gastric-type adenocarcinoma in a case of OHVIRA syndrome

Background : We report the urinary cytologic findings of a case of adenocarcinoma exhibiting gastric differentiation.Case : A 40-year-old woman presented with postrenal acute renal failure and was diagnosed by magnetic resonance imaging as having a tumor of the posterior wall of the bladder, in addition to the OHVIRA (obstructed hemivagina and ipsilateral renal anomaly) syndrome. Urinary cytology showed mildly overlapping clusters of atypical glandular cells in an inflammatory background. Cell clusters with orange to yellowish intracytoplasmic mucin, cell clusters with pinkish to orange mucin on the apical surface, and small clusters of cuboidal cells with distinct cell borders and clear cytoplasm were identified. Cervical cytology showed the same cytologic findings, although the imaging tests showed no evidence of uterine tumor. Histological examination of the bladder tumor showed invasive adenocarcinoma exhibiting a serrated appearance, but no component of urothelial carcinoma. On immunohistochemistry, the tumor cells were focally positive for M-GGMC-1 and MUC6. Based on the findings, the tumor was diagnosed as adenocarcinoma of the bladder exhibiting gastric differentiation.Conclusion : When mildly overlapping clusters of glandular cells with distinct cell borders, clear cytoplasm, and bland nuclei are identified on urinary cytology, gastric-type adenocarcinoma should be considered in the differential diagnosis.