[Nephrogenic adenoma: study of 9 cases, including one of the urethra in a 14-year-old male]

OBJECTIVES

To review our series of nephrogenic adenoma and compare our results with those reported in the literature.

METHOD

The records of our Department of Pathology were reviewed to determine the cases of nephrogenic adenoma diagnosed at our center. The clinical features, diagnostic aspects, pathological findings, treatment and outcome are presented.

RESULTS/CONCLUSIONS

Nephrogenic adenoma is a rare lesion, probably arising from nephrogenic metaplasia caused by injury to the urothelial mucosa. The site of presentation is frequently the bladder, followed by the urethra. The diagnosis is based on the histopathological findings, which can be occasionally equivocal. The cases described in the present series were benign. To date there is no established therapeutic approach. We performed TUR in two patients, antibiotic therapy was administered in one patient and 4 patients were managed conservatively. Two of our patients had no control evaluation following biopsy of the lesion. In 2 of the 4 patients that were managed conservatively, the lesion remitted spontaneously.

[Can the prostatic capsule be preserved during cystectomy for bladder tumors: a study of urethral and prostatic involvement in the cystectomy specimens]

OBJECTIVES

To evaluate the frequency of urethral and prostatic lesions on cystectomy specimens for bladder tumour.

MATERIAL AND METHODS

This retrospective histological study was based on 260 specimens: radical cystectomies performed in 7 operative sites. The prostate and urethra were analysed in 3 planes (upper, middle and lower thirds). The apex was studied separately. Urethral invasion was identified by continuity of the tumour or by the presence of vesical CIS.

RESULTS

Urethral involvement is frequent (30.6% cases) essentially due to contiguous invasion (43/80). CIS is the second pathological association (44 urethral CIS/75 bladder CIS). Prostatic adenocarcinoma was present in 17.8% of cases with a Gleason score > 6 for 30% of lesions.

CONCLUSION

The high frequency of urethral and prostatic involvement does not justify preservation of the prostate during cystectomy. A serial prospective study should define the precise criteria able to minimize the risk of conservative surgery.

[A case of posterior urethral polyp in a child]

A case of posterior urethral polyp in a child is reported. A 14-year-old boy presented to our hospital with the chief complaint of a sense of residual urine. Ultrasound sonography and cystoscopy showed a posterior urethral tumor (1.5 cm x 1.8 cm). Transurethral resection was performed, and the pathological diagnosis was a fibrous polyp. One year after transurethral resection, the patient showed no signs of recurrence. Only 8 cases of posterior urethral polyp in children have been previously reported in the Japanese literature.

Altered expression of transforming growth factor betas during urethral and bulbourethral gland tumor progression in transgenic mice carrying the androgen-responsive C3(1) 5' flanking region fused to SV40 large T antigen

We demonstrate that targeted expression of SV40 large T antigen (TAg) to the urethral (periurethral) and bulbourethral gland epithelium leads to adenocarcinoma formation in these tissues after 7 months of age, which are extremely rare sites for spontaneous tumor formation in humans. The development of proliferative lesions in the urethral gland predictably follows a temporal course of progression with approximately one third of male animals developing urethral tumors by 1 year of age. Tumor progression in these organs correlates to the level of TAg and p53 expression. Immunoprecipitation confirmed that SV40 TAg protein was bound to p53 and Rb p110 in vivo. Expression of transforming growth factor beta (TGFbetas) was evaluated during tumor progression of urethral gland carcinomas. Elevations of intracellular and extracellular TGFbeta1 and extracellular TGFbeta3 were found in preneoplastic and neoplastic lesions, suggesting that increased TGFbetas may augment tumor growth. c-Met expression showed a tendency for increased expression in the urethral gland carcinomas. We speculate that the directed expression of SV40 TAg by the hormone responsive C3(1) gene and subsequent tumor formation in these organs is influenced by androgens, since these tissues and carcinomas express androgen receptor (AR) and arise only in male transgenic mice. Several cell lines established from the urethral carcinomas were also shown to express AR, but are not androgen dependent in culture. To our knowledge, this is the first transgenic animal model for urethral and bulbourethral carcinomas. This transgenic mouse model and the cell lines derived from it may provide a unique opportunity for dissecting molecular mechanisms involved in the tumorigenesis of these organs which otherwise rarely develop cancer.

[Polyps of the posterior urethra in children. Apropos of a case]

Posterior urethral polyp is a rare disease, predominantly affecting boys. The authors report the case of an 10-month-old boy admitted to hospital with acute urine retention. The diagnosis of polyp was established on cystourethrography, ultrasonography and endoscopy. The polyp was resected via a bladder incision after failure of transurethral resection. Posterior urethral polyp is a benign tumour whose clinical presentation is dominated by signs of lower urinary tract obstruction. Cystourethrography and ultrasonography confirm the diagnosis and assess the repercussions on kidneys and bladder. Endoscopy has a double role: diagnostic and therapeutic.

[Epidermoid carcinoma of the bladder. Apropos of 14 cases]

The authors report 14 cases of squamous cell carcinoma of bladder over a period of 20 years. All patients were male, with a mean age of 56 years. A history of urogenital bilharziasis was reported in 2 patients and 10 patients were smokers. Hematuric cystitis was the commonest presenting feature and infiltration of the bladder base was detected on rectal palpation in 10 patients. The patients consulted late in the course, at the stage of upper urinary tract repercussions (11 cases) and computerized tomography showed locoregional extension in 5 cases. 12 total cystoprostatectomies were performed and 2 patients were treated exclusively by radiotherapy. The long-term course was marked by urethral recurrence in 3 patients. The etiopathogenesis, diagnosis, treatment and clinical course of these tumors, which are often aggressive, are reviewed.

Glandular-type inverted papilloma of the prostatic urethra

A case of inverted papilloma of glandular type in the prostatic urethra of a 65 year-old man is reported. The case was asymptomatic and incidentally discovered on histopathologic study of transurethral resection (TUR) specimens from benign prostatic hyperplasia. The literature concerning this rare entity is reviewed and briefly commented.

[Myomatosis of rare localization]

We described three cases of female patients with myomata of rare location. A 37 year old female with abnormal genital bleeding, secondary to cervical neoplasm; underwent total abdominal hysterectomy in 1993. A year later an excision of anterior vaginal dependent neoplasm was performed. A 16 year old female with Bartholinitis. Excision of vulvar tumor was performed. A 35 year old female with urinary stress incontinence, hematuria, referring foreign body sensation in the vagina, with a neoplasm in the urethra. The patient underwent for excision of the tumor. In all three cases the neoplasm excised underwent histopathologic analysis resulting as vulvar, vaginal and urethral myomata.

Prostatic duct adenocarcinoma: a cytologic and histologic case report with review of the literature

Prostatic duct adenocarcinoma is a rare tumor which typically involves the prostatic urethra as its primary site. Due to this unique location, prostatic duct adenocarcinoma may shed cells into urine specimens which may be detected by cytologic techniques. This report describes the cytologic and histologic features of a case of prostatic duct adenocarcinoma involving the prostatic urethra. Key features which differentiate this neoplasm from the more common transitional carcinomas and the potentially confounding prostatic acinar adenocarcinomas include epithelial clusters with prominent nuclear overlap and nuclear grooves. A comparison to the five previously reported cases is presented.

Transitional cell carcinoma of the fossa navicularis

We report a case of transitional cell carcinoma of the fossa navicularis in an elderly white male. The patient presented in urinary retention, with a large exophytic mass at the external urethral meatus. Both the pathogenesis and natural history of this highly unusual tumor are unclear. Treatment depends on grade and stage of disease. Transurethral resection and fulguration have been successfully used to treat superficial lesions. Segmental resection and partial penectomy, with or without inguinal lymph node dissection, form the mainstay of treatment for invasive disease. The role of chemotherapy for advanced disease is unknown.

[Low-grade papillary transitional-cell carcinoma of the distal urethra with focal squamous differentiation and association with human papillomavirus types 6-11]

OBJECTIVE

To report a case of transitional cell carcinoma of the urethra associated with human papilloma virus (HPV) infection in areas of squamous differentiation of the neoplasm.

METHODS/RESULTS

A 32-year-old male with a previously treated condylomata acuminatum of the prepuce presented with a verrucous lesion in the penile meatus, corresponding to well differentiated, low grade papillary transitional cell carcinoma with squamous differentiation. Histological viral expression of HPV was confirmed by in situ hybridization.

CONCLUSION

We emphasize the rare presentation of transitional carcinoma in the distal urethra associated with HPV infection.

Incidence of urethral involvement in female bladder cancer: an anatomic pathologic study

OBJECTIVES

To evaluate risk factors for urethral involvement in female patients undergoing cystectomy for bladder cancer and to define potential candidates for orthotopic continent urinary diversion.

METHODS

From 1990 to 1996, 43 female patients underwent cystectomy for primary bladder malignancy. Bladder mapping studies were performed with special attention to tumor location, multifocality, pathologic stage and grade, presence of carcinoma in situ (CIS), and the relationship of these factors to urethral involvement.

RESULTS

Of the 43 patients evaluated, 7 (16.3%) had urethral involvement by tumor. Two patterns of urethral invasion were identified: 5 patients had tumors in the vascular or lymphatic channels of the periurethral tissue, and 2 had tumors in the mucosa or submucosa. Three of the 12 patients with tumors located at the trigone and 4 of the 26 with CIS of the bladder had tumor in the urethra. Three of the 5 patients with vaginal involvement had tumor in the urethra. Only vaginal involvement was significantly associated with urethral involvement (P = 0.02).

CONCLUSIONS

Vaginal involvement was the only preoperative factor that was associated with presence of tumor in the urethra. Five patients with urethral involvement had submucosal tumors without concomitant CIS of the urethra. Before the performance of orthotopic urinary diversions, intraoperative full-thickness bladder neck biopsies are needed to accurately evaluate the female urethra.

Hemangioma of the prostatic urethra: hematospermia and massive postejaculation hematuria with clot retention

The case of a 53-year-old man with hematospermia and massive postejaculation hematuria that caused urinary retention is described. This is the sixth case in the English and Japanese language literature. Cystourethroscopic examination revealed that a solitary raised tumor was present just distal to the vermontanum, and that bleeding was from its apex. Histologic examination of an excisional biopsy sample showed features compatible with hemangioma.

Urethral obstruction in a dog: an unusual presentation of T-cell lymphoma

A six-year-old, neutered male golden retriever was presented for evaluation of stranguria. Upon physical examination, the dog was thin and actively was straining to urinate. A large, firm bladder was palpated. Urethral pressure profilometry was indicative of a focal, nondistensible lesion in the midurethra which was confirmed with a positive contrast urethrogram. Ultrasonographically, a well-marginated tubular mass was visualized midurethra, and a region of small bowel was noted to have an annular mural thickening with corrugations of the mucosal surface. The abnormal areas were aspirated percutaneously, and lymphoma was diagnosed upon cytological examination of the aspirated material. At necropsy, a diagnosis of diffuse T-cell lymphoma was confirmed.

[Primary malignant melanoma of the female urethra: a case report]

The 20th case of primary malignant melanoma of the female urethra in the Japanese literature is reported. An 86-year-old woman presented with urethral bleeding. A hemorrhagic cheery-sized mass was identified at the urethral meatus, which extended into the vaginal mucosa, and was diagnosed as malignant melanoma after biopsy. Surgical treatment was abandoned because she had dementia and bilateral inguinal lymphadenopathy. She had no symptoms during the following 4 months.

Small cell carcinoma arising from the outer urethral orifice: a case report examined by histologic, ultrastructural and immunohistochemical methods

A case of small cell carcinoma arising in the outer urethral orifice is presented. The resected tumor showed a proliferation of small round or fusiform neoplastic cells in the submucosa. Tumor cells were arranged in sheets or a trabecular manner and possessed markedly hyperchromatic nuclei with a high N:C ratio, closely resembling small cell carcinoma of the lung. Characteristically, pagetoid intraepithelial spreading could be identified. However, there was no evidence of in situ transitional cell carcinoma and adeno- or squamous cell carcinoma components anywhere. Ultrastructurally, each tumor cell contained only a few membrane-bound cored granules measuring 60-100 nm, which were compatible with neurosecretory granules, and desmosome-like intercellular attachments, but lacked aggregated microfilaments. By immunohistochemical examination, tumor cells were positive for epithelial markers, such as cytokeratin and epithelial membrane antigen, and neuron specific enolase, but negative for any other neuro-endocrine markers. Extensive systemic examination failed to show the primary site to be other than the outer urethral orifice. These findings indicate that the current tumor is a small cell carcinoma with neuro-endocrine differentiation arising from the outer urethral orifice.

Leiomyoma of the female urethra and bladder: report of twenty-three patients and review of the literature

OBJECTIVES

Our purpose was to review what may be the largest experience of bladder and urethral leiomyomas from a single institution.

STUDY DESIGN

A retrospective review was done of 23 female patients with emphasis on presentation, symptoms, and operative approach for excision.

RESULTS

The majority of bladder and urethral leiomyomas in this series were asymptomatic, nonobstructive, or incidental (discovered at surgery for another entity). Ten patients had a palpable mass on physical examination. Two patients had pain as a presenting complaint. The route of operative excision was transvaginal (10 patients), transurethral (6 patients), or abdominal (6 patients). One patient had the leiomyoma removed elsewhere with a resultant vesicovaginal fistula.

CONCLUSIONS

Corollaries should be sought with the experience of uterine leiomyomas, which are histologically identical to bladder leiomyomas. Asymptomatic, nonobstructive, and nonproblematic leiomyomas should not serve as an indication for primary operation. Pedunculated endovesical lesions may be an exception because of the ease of transurethral removal and their tendency to cause future symptoms. Ultrasonographic imaging, cystoscopy, and biopsy should be considered to allow observation and follow-up of leiomyomas. Future investigative cytogenetic studies should be considered on these mesenchymal tumors.

Primary carcinomas of the urethra

Urethral carcinomas are rare, and information reported in the literature is relatively limited. In this review, the authors present separate discussions on the pathology of carcinomas occurring in men and women with emphasis on the diverse histological subtypes. Because tumor type and prognosis correspond to anatomic location, normal anatomy and histology have been given due consideration. Of particular note in the recent literature is an expanded experience with clear cell carcinoma, a distinctive tumor primarily of the female urethra that has generated considerable interest with respect to its prognosis and relationship to urethral diverticulum. The authors use this review to illustrate several features of the pathology of these neoplasms synthesize the literature, and place into perspective the clinical, pathological, and prognostic features.

[Primary carcinoma of the female urethra: report of five cases]

Between 1988 and 1996, we treated five patients with primary carcinoma of the female urethra between 65 and 79 years of age. Presenting symptoms included a urethral mass in 2 patients, hematuria in 1, dysuria in 1 and urethral bleeding in 1. Histopathology revealed squamous cell carcinoma in 4 cases and transitional cell carcinoma in 1. Clinical stage according to Grabstald's classification comprised Stage A in two cases, Stages B, C and D in one each. The modes of treatment were surgical resection alone in two, radiation therapy alone in two, and surgery with adjuvant chemotherapy in one case. Three patients without disease and two with disease are olive from 5 to 87 months after diagnosis.