RESUMO
Objective: The analysis of the etiopathologic; diagnostic and therapeutic aspects of the primary adenocarcinoma of the bladder. Patients and Methods: We report on a series of 7 cases of primary adenocarcinoma of the bladder out of a total of 564 cases of bladder tumors seen at our institution during a period of 14 years (1989-2003). All 7 patients with primary adenocarcinoma of the bladder presented with gross hematuria. Treatment consisted of chemotherapy using 5-fluorouracil (5-FU) in 3 cases where the tumor was locally advanced or metastatic; radical cystectomy with bilateral pelvic lymph node dissection and urinary diversion in 2 cases where the tumor was located in the bladder neck and trigone; partial cystectomy with pelvic lymph node dissection and bladder augmentation ileoplasty followed by an adjuvant chemotherapy in one case where the tumor was located at the dome of the bladder; and transurethral bladder resection followed by a chemotherapy with intravesical instillation of mitomycin-C in the remaining patient with superficial lesions. Follow-up ranged from 6 months to 15 years with a mean follow-up of 93 months. Results: The two patients treated by radical cystectomy had no recurrence after 12 months; while the patient treated by transurethral resection followed by intravesical instillation of mitomycin-C was free of disease 15 years after the intervention. The patient treated by partial cystectomy did not show any local recurrence after 10 months. Among the patients treated by chemotherapy (5-FU); a partial response was achieved in two with a mean survival of 12 months; while the remaining patient died within 6 months from treatment. Conclusion: Adenocarcinoma of the bladder is often diagnosed late. No consensus on therapy has been achieved so far. Radical cystectomy remains the gold standard for organ-confined tumors. Superficial lesions are very rare and may be treated conservatively