Rare but Aggressive: Diagnostic challenges and emerging therapeutic approaches of primary bladder adenocarcinoma

Primary bladder adenocarcinoma is a rare and aggressive malignancy representing 0.5–2% of all bladder cancers and is associated with a poor prognosis. This study aimed to describe the epidemiological, clinical, pathological, therapeutic, and prognostic characteristics of primary bladder adenocarcinoma. We conducted a retrospective analysis of four patients diagnosed with primary bladder adenocarcinoma between January 2014 and December 2023 at the Medical Oncology Department of Hassan II University Hospital in Fez, Morocco. Clinical presentation, pathological findings, treatments, and outcomes were evaluated. The mean age was 56 years (range: 45–69 years), with a predominance of males (75%). Macroscopic hematuria was the main presenting symptom in all patients. Three patients were metastatic at diagnosis and received first-line platinum-based chemotherapy combined with gemcitabine. One patient with localized disease received neoadjuvant chemotherapy without response and was subsequently lost to follow-up. No patients underwent surgery or radiotherapy. Disease progression occurred in two patients after a mean interval of seven months, and second-line chemotherapy with paclitaxel was administered. The median progression-free survival was 5.25 months, and the median overall survival was 6.25 months. Primary bladder adenocarcinoma remains a rare and aggressive tumor that is often diagnosed at an advanced stage. Therapeutic options are limited, and outcomes remain poor. Further studies are needed to improve management and prognosis.