Proceedings: Tumors of the urethra in men and women

Papillary adenocarcinoma of the prostatic urethra with clear-cell appearance

The second reported papillary prostatic urethral carcinoma displaying an unusual clear-cell or so-called mesonephroid histologic appearance is described. Neoplasms arising from the utricular region have generated considerable discussion of their histogenesis and hormone-responsiveness. A review of the literature as well as consideration of this case suggests that the lesion's clear-cell appearance should not be used as evidence for müllerian derivation from the utricle. The authors favor a periurethral gland origin for this particular tumor.

Melanoma of the female urethra

Our patient had a highly malignant and poorly differentiated tumor in the distal urethra. A conservative operation was performed because the precise nature of the tumor was not clear with light microscopy. An ultrastructural study established the final diagnosis of malignant urethral melanoma and anterior exenteration was performed. An aggressive operation should be considered as the primary approach once malignant melanoma is diagnosed. Ultrastructural studies should be introduced early in the diagnostic process when light microscopy is insufficient to provide a definitive diagnosis of urethral malignancy.

An adenosquamous carcinoma of the male urethra with hypercalcemia

A case of primary adenosquamous carcinoma of the urethra observed in a 52 year old man is described. The patient had a history of recurrent scrotal abscess for seven and one-half months following trauma to the region. The serum calcium level was found to be elevated when carcinoma was diagnosed. The calcium level returned to normal after resection of the lesion but rose again when local recurrence and metastasis developed. He died three and one-half months after the surgery.

Mixed mucinous and papillary adenocarcinoma involving male urethra, probably originating in periurethral glands

The case of a patient with primary adenocarcinoma involving the urethra is described. Morphologic evidence supporting an origin in the periurethral glands is presented. The urologist and pathologist must maintain a high index of suspicion in evaluating patients with urethral structure or urethrocutaneous fistulae because superficial transurethral biopsy may fail to obtain adequate depth to demonstrate malignancy.

Primary urethral neoplasms: review of 30 cases

The recent literature shows our findings on primary urethral neoplasms to be consistent with others, although we did not show an increased incidence of these neoplasms in female over male subjects. Similarly, we recommend an operation with or without irradiation, depending on the stage and location of the lesion. The over-all prognosis of urethral neoplasms remains poor. However, the distal urethral lesions in male and female subjects are easier to approach surgically and seem to be diagnosed earlier in the progression of this disease than the more proximally advanced tumors. These early staged and distal neoplasms greatly improve the changes of long survival. The delay in diagnosis gives this neoplasm its poor prognosis. In men the prognosis probably could be improved by more aggressive evaluation of stricture disease, especially when the need for dilation becomes frequent. In women we believe that the caruncle should be biopsied if it shows signs of progression or remains symptomatic (pain, bleeding and so forth). If a 1 to 2-month course of antimicrobials does not resolve this lesion we recommend biopsy. A relationship between tumor and a diverticulum has been noted in the literature, as in 1 of our cases of adenocarcinoma in a female patient. Whether this relationship could be explained on the basis of recurrent infection and stasis remains theoretical. In conclusion, early diagnosis, accurate staging and aggressive treatments are the means for cure of this disease.

Resectoscope loop for urethral biopsy following cystectomy in the male patient

A small resectoscope loop, sans scope, has been used to obtain tissue from the male urethral mucosa for diagnostic and therapeutic purposes.

Conservative management of low grade neoplasms of the male urethra: a preliminary report

Between 1965 and 1977, 8 men with low grade urethral neoplasms were treated with local excision or a combination of local excision and local chemotherapeutic agents. The tumors were in the anterior urethra in 5 cases and the posterior urethra in 3. Histology included 2 transitional cell papillomas, 3 squamous cell carcinomas, 1 transitional cell carcinoma, 1 mesonephric carcinoma and 1 intraductal transitional cell carcinoma in situ. All neoplasms were controlled by local measures for 1 to 13 years. This experience suggests that local treatment may be an acceptable alternative to a radical operation in certain well localized low grade urethral neoplasms in men.

Topical application of 5-fluorouracil cream: a therapeutic alternative in the treatment of urothelial tumours of the distal urethra. A case report

A case of secondary urothelial tumour of the distal male urethra is presented. The tumour was successfully treated by local application of 5-Fluorouracil cream. No side-effects were observed. Repeated topical applications of 5-Fluorouracil may be a therapeutic alternative to surgical treatment of urothelial urethral tumours.

Villous polyps of the urethra: a report of two cases

Two patients with villous polyps of the prostatic urethra are described. The article supports previous observations that the lesion has the morphologic appearance of prostatic tissue. A review of the literature reveals that this rare lesion appears to be specific for the prostatic urethra and behaves as a benign tumor.

Radiotherapy in the treatment of carcinoma of the male urethra

Carcinoma of the male urethra is an uncommon tumor. Four patients are reported in this investigation. All the patients belonged to the middle age group under the age of 45 years. None of them suffered from preivous urethral structure. The most unusual presentation was impotence due to the involvement of the corpus spongiosum of the penis. Urethrogram and urethroscopy with biopsy are the most useful aids in the diagnosis. All of them had epidermoid carcinoma nad were treated with external radiation therapy. Two patients with distal urethral lesions without metastases responded well with a 4 and 5 years survival and disappearence of the tumor. Two patients with extensive bulbomembranous lesions had palliation with relief of pain and partial regression of the tumor. Radiation therapy in a properly selected patient with an early lesion gives gratifying result.

Primary carcinoma of the male urethra developing after urethroplasty for stricture

Most investigators agree that a urethral stricture is a predisposing cause of primary carcinoma of the urethra. The etiology of the carcinoma is probably chronic irritation. The role of squamous metaplasia in the etiology is discussed briefly. A case of primary squamous cell carcinoma of the urethra occurring 4 years after a first stage urethroplasty is reported and 2 cases from the literature are described. The suggested origins of urethral malignancy after urethroplasty are 1) unrecognized malignancy at operation, 2) premalignant mucosal changes that progress postoperatively, 3) recurrence of stricture with continued irritation leading to malignant metaplasia and 4) malignant change in the urethroplasty skin flaps. Although rare, primary male urethral carcinoma is a deadly disease. The hope for early diagnosis is a high index of suspicion during urethroplasty and in subsequent followup studies. The patient presented herein also exhibited pseudohyperparathyroidism as a result of the malignancy.

Urethral carcinoma after radiation therapy for mixed prostatic carcinoma

The first case of transitional cell carcinoma of the bulbous urethra occurring 8 months after radiation therapy for mixed ductal and adenocarcinoma of the prostate is presented. The significance of the sequential appearance of these tumors is discussed. Periodic endoscopic evaluation appears warranted following the diagnosis of transitional cell carcinoma of the prostate to ensure early recognition of secondary urethral lesions or bladder extension of the tumor.

Primary carcinoma of fossa navicularis

A case of primary carcinoma of the fossa navicularis of the male urethra is discussed. The lesion presented as an ulcerative process that circumferentially involved the external urinary meatus in a sixty-three-year-old man. Initially, the lesion was confused with a superficial carcinoma of the penis, since results of urethroscopic examination were normal. Following midshaft penectomy, despite normal gross appearance of the distal urethra, histologic examination indicated poorly differentiated epidermoid carcinoma along the mucosa of the distal urethra up to the line of surgical resection. Subsequent total penectomy showed only a small area of residual tumor at the line of previous resection. Lymphadenectomy was not performed. The patient remains alive without evidence of residual disease five years later.

Carcinoma in situ in urethral diverticulum: pitfalls of marsupialization alone

Carcinoma in situ was found in a urethral diverticulum in a fifty-one-year-old black woman. The discovery of this lesion lends support to the fact that biopsy of the urethral diverticulum should be performed even if a Spence-Duckett procedure is carrier out.

Recurrent intraurethral proliferation of ectopic prostatic tissue associated with hematuria

The first reported case of recurrent intraurethral proliferation of ectopic prostatic tissue associated with hematuria is presented.

Primary carcinoid tumor of the urethra

The first reported case of a carcinoid tumor of the urinary tract is presented. Because of rapid local recurrence and distant spread early radical surgery is recommended. Several methods of palliation of the carcinoid syndrome-surgical, pharmacologic and chemotherapeutic-are discussed.