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Sugawara E, Shigematsu Y, Amori G, Sugita K, Yonese J, Takeuchi K, Inamura K. CDX2- and PAX8-Expressing Subtypes in Female Urethral Adenocarcinoma: Pathogenesis Insights through Immunohistochemical and Morphological Analyses. Diagnostics (Basel) 2023; 13:2408. [PMID: 37510152 PMCID: PMC10377779 DOI: 10.3390/diagnostics13142408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Female urethral adenocarcinoma has attracted attention as a rare tumor type based on its differential pathogenesis from its male counterpart. However, to date, our knowledge concerning its immunohistochemical and morphological characteristics remains limited due to the small number of cases studied. In this study, nine consecutive cases of female urethral adenocarcinoma were used for immunohistochemical and morphological characterization of the tumor based on semi-comprehensive immunohistochemical analysis and detailed morphological evaluations. Our immunohistochemical assay revealed two subtypes of female urethral adenocarcinoma with distinctive staining patterns: the CDX2- and PAX8-expressing subtypes. The former stained positive for other intestinal markers (e.g., HNF4α and TFF1) as well (7 of 7 cases); the latter stained negative for these intestinal markers (0 of 2 cases) but stained positive for clear cell carcinoma markers (e.g., Napsin A and HNF1β) (2 of 2 cases). Regarding cytokeratins, the former displayed a CK7- and CK20-positive immunoprofile (7 of 7 cases); the latter exhibited a CK7-positive and CK20-negative immunoprofile (2 of 2 cases). Morphologically, CDX2- and PAX8-expressing subtypes resembled intestinal-type adenocarcinoma and clear cell carcinoma (occurring in gynecological organs), respectively. The semi-comprehensive immunoprofiling data presented in this study can potentially contribute to the correct diagnosis of this rare tumor type. Finally, our study represents an important basis for future investigations aiming to further elucidate the details and origin of female urethral adenocarcinoma, and it can potentially contribute to developing diagnostic and therapeutic strategies for treating this malignancy.
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Affiliation(s)
- Emiko Sugawara
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Yasuyuki Shigematsu
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Gulanbar Amori
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Keisuke Sugita
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Junji Yonese
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Kengo Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Kentaro Inamura
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
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A PAX-8-Positive Female Urethral Adenocarcinoma, Intestinal-Type: A Case Report with Diagnostic Challenges and a Review of the Literature. Case Rep Pathol 2023; 2023:8323821. [PMID: 36820320 PMCID: PMC9938771 DOI: 10.1155/2023/8323821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 07/05/2022] [Accepted: 02/01/2023] [Indexed: 02/13/2023] Open
Abstract
Female urethral adenocarcinoma (FUA) is extremely rare. It is an aggressive malignancy, and clear cell and columnar/mucinous ("intestinal") represent the two primary histologic subtypes. Diagnosis is often delayed in patients because of their vague symptomatology; hence, they present with an advanced disease and a poor prognosis. The rarity of FUA brings challenges when determining treatment and management, and treatment guidelines for various stages are lacking. We report an intestinal-type FUA that developed from inflammation-related metaplasia in urethral diverticulum with positive paired box 8 (PAX-8) staining. In addition to intestinal-type FUA being extremely rare, this particular entity exhibiting PAX-8 positivity has not been previously described, to the author's best knowledge. The present report highlights the importance of clinical and radiological assessment as well as histomorphologic and immunophenotypic features for an accurate diagnosis of this rare and aggressive malignancy.
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Management of Primary Female Urethral Adenocarcinoma: Two Rare Case Reports and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010109. [PMID: 36676733 PMCID: PMC9865078 DOI: 10.3390/medicina59010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
Primary urethral adenocarcinoma in females is an extremely rare malignancy with unclear origin and only a few retrospective cases have been reported. The controversy continues to exist over the origin of primary urethral adenocarcinoma from periurethral glands (which include the Skene's glands), urethritis glandularis or intestinal metaplasia. Herein, we report one case of a 49-year-old female with distal urethral adenocarcinoma who presented with obstructive voiding. Abdominal and pelvic CT scans and chest radiology were unremarkable. Biopsy of the mass confirmed urethral adenocarcinoma. The patient underwent partial ureterectomy and was disease-free at the 2-years follow-up period. We also present another extremely rare case of primary urethral adenocarcinoma with mucinous features in a 58-year-old female who initially complained of external urethral orifice itching with painless urethral bleeding and was treated with local excision. The patient has not received any neoadjuvant or adjuvant therapy, and experienced tumor recurrence, inguinal lymph nodes metastasis, and even local iliopsoas metastasis during over 10-years follow-up. In conclusion, our current study emphasizes the importance of imaging studies and biopsy in making an accurate preoperative diagnosis of this rare disease, and further highlights the role of multimodal therapy. A combination of radiotherapy, chemotherapy and surgery is recommended for the optimal local and distant disease control. Moreover, better medical compliance and regular follow-up are required in these patients.
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Snee(a)k Peek from Skene! INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Guo J, Liang X, Zheng Y, Ma J. Progress in the treatment of urethral adenocarcinoma. J Cancer Res Clin Oncol 2022; 149:2693-2698. [PMID: 36414814 DOI: 10.1007/s00432-022-04481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Urothelial adenocarcinoma (UA) is a rare subtype of primary urothelial carcinoma, which is more common in women and has a poor prognosis. Because of their low incidence, most of the existing literature is based on case reports and there is a lack of comprehensive literature on this type of tumor. PURPOSE This article provides a comprehensive and systematic review of the epidemiology, pathological types, treatment, and prognosis of UA. Especially in the treatment section, we reviewed the various treatment methods including surgery, radiotherapy, chemotherapy, immunotherapy and molecular targeted therapy. This review aims to provide a theoretical basis for the clinical diagnosis and management of UA. METHODS We reviewed the relevant literature of UA from Pubmed. CONCLUSION There is no standard treatment for UA. Multidisciplinary therapy, including surgery, radiotherapy and chemotherapy, is the current trend. Immunotherapy and molecular targeted therapy will also become viable options for the treatment of UA in future.
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Zanatelli M, Colleta SJ, Guerra LHA, Santos FCA, Góes RM, Vilamaior PSL, Taboga SR. Prolactin promotes a partial recovery from the atrophy of both male and female gerbil prostates caused by castration. Reprod Biol Endocrinol 2021; 19:94. [PMID: 34158080 PMCID: PMC8218528 DOI: 10.1186/s12958-021-00777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The male and female prostates are controlled by steroid hormones, suffering important morphological and physiological changes after castration. Prolactin is involved in the regulation of the male prostate, having already been identified in the tissue, acting through its receptor PRLR. In the Mongolian gerbil, in addition to the male prostate, the female prostate is also well developed and active in its secretion processes. The aim of the present study was to evaluate the effects of exposure to exogenous prolactin in the prostate of both intact and castrated male and female gerbils in order to establish if prolactin administration can sustain prostate cell activity in conditions of sexual hormone deprivation. METHODS The morphological analyses were performed by biometric analysis, lesion histological analysis and morphometric-stereological aspects. In addition, immune-cytochemical tests were performed for prolactin and its receptor, as well as for the receptors of androgen and oestrogen and serum prolactin dosage. All data were submitted to ANOVA or Kruskal-Wallis tests for comparison between groups. P < 0.05 was considered to be statistically significant. RESULTS The results showed a strong influence of prolactin on the morphology of the prostate, with the development of important epithelial alterations, after only 3 days of administration, and an expressive epithelial cell discard process after 30 days of administration. Prolactin acts in synergy with testosterone in males and mainly with oestrogens in females, establishing different steroid hormonal receptor immunoreactivity according to sex. It was also demonstrated that prolactin can assist in the recovery from some atrophic effects caused in the gland after castration, without causing additional tissue damage. CONCLUSIONS The prolactin and its receptor are involved in the maintenance of the homeostasis of male and female gerbils, and also cause distinct histological alterations after exogenous exposure for 3 and 30 days. The effects of prolactin are related to its joint action on androgens and oestrogens and it can also assist in the recovery from the atrophic effects of castration.
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Affiliation(s)
- Marianna Zanatelli
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas - UNICAMP, SP, Campinas, Brazil
| | - Simone Jacovaci Colleta
- Laboratory of Microscopy and Microanalysis, Department of Biology, São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, Jardim Nazareth, SP, 15054-000, São José do Rio Preto, Brasil
| | - Luiz Henrique Alves Guerra
- Laboratory of Microscopy and Microanalysis, Department of Biology, São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, Jardim Nazareth, SP, 15054-000, São José do Rio Preto, Brasil
| | | | - Rejane Maira Góes
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas - UNICAMP, SP, Campinas, Brazil
- Laboratory of Microscopy and Microanalysis, Department of Biology, São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, Jardim Nazareth, SP, 15054-000, São José do Rio Preto, Brasil
| | - Patricia Simone Leite Vilamaior
- Laboratory of Microscopy and Microanalysis, Department of Biology, São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, Jardim Nazareth, SP, 15054-000, São José do Rio Preto, Brasil
| | - Sebastião Roberto Taboga
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas - UNICAMP, SP, Campinas, Brazil.
- Laboratory of Microscopy and Microanalysis, Department of Biology, São Paulo State University - UNESP/IBILCE, Rua Cristóvão Colombo, 2265, Jardim Nazareth, SP, 15054-000, São José do Rio Preto, Brasil.
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Muto M, Inamura K, Ozawa N, Endo T, Masuda H, Yonese J, Ishikawa Y. Skene's gland adenocarcinoma with intestinal differentiation: A case report and literature review. Pathol Int 2017; 67:575-579. [DOI: 10.1111/pin.12571] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mariko Muto
- Division of Pathology; The Cancer Institute; Department of Pathology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Kentaro Inamura
- Division of Pathology; The Cancer Institute; Department of Pathology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Naoko Ozawa
- Division of Pathology; The Cancer Institute; Department of Pathology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Takashi Endo
- Division of Pathology; The Cancer Institute; Department of Pathology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Hitoshi Masuda
- Department of Urology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Junji Yonese
- Department of Urology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Yuichi Ishikawa
- Division of Pathology; The Cancer Institute; Department of Pathology; The Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
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8
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Primary enteric-type mucinous adenocarcinoma of the urethra in a patient with ulcerative colitis. Int Surg 2016; 99:669-72. [PMID: 25216440 DOI: 10.9738/intsurg-d-13-00073.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary carcinoma of the male urethra accounts for less than 1% of malignancies in men. Mucinous adenocarcinoma of the urethra is extremely rare, and its biologic behavior is poorly understood. We present herein a rare case of mucinous urethral adenocarcinoma in a male patient with longstanding ulcerative colitis and multiple sclerosis. The patient presented with a voluminous pelvic mass; core biopsy of the lesion demonstrated a mucus-producing adenocarcinoma. Given the patient's history of subtotal colectomy, preoperative diagnosis was oriented towards a rectal stump adenocarcinoma. The patient underwent a pelvic exenteration: surprisingly, histology marked the prostatic urethra as the primary lesion site.
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9
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Tatsumi K, Schlappe B, Everett EN, Gibson PC, Mount SL. Primary vaginal mucinous adenocarcinoma of intestinal type, associated with intestinal metaplasia of Skene ducts in a diethylstilbestrol-exposed woman. Am J Clin Pathol 2015; 144:790-5. [PMID: 26486744 DOI: 10.1309/ajcpvz0qnluo7ofe] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Primary mucinous vaginal adenocarcinoma of intestinal type is an extremely rare malignancy of uncertain histogenesis, which makes for a diagnostic challenge. We report a case and describe the histopathologic features and the unusual immunoprofile of this rare entity. METHODS We report a case of vaginal mucinous adenocarcinoma of intestinal type in a diethylstilbestrol-exposed woman in which intestinal metaplasia of the Skene duct was found at the time of recurrence. RESULTS As the histogenesis of primary vaginal intestinaltype adenocarcinomas remains uncertain, the finding of Skene duct metaplasia in association with invasive adenocarcinoma lends support to the origin of vaginal mucinous adenocarcinomas of intestinal type to be metaplasia, at least in some cases. Such an origin accounts for the unusual immunohistochemical profile, which raises concern for a metastatic adenocarcinoma of gastrointestinal origin. CONCLUSIONS Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease.
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10
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Bagshaw HP, Williams NL, Huang YJ, Tward JD, Gaffney DK. Palladium interstitial implant in combination with external beam radiotherapy and chemotherapy for the definitive treatment of a female urethral carcinoma. Gynecol Oncol Rep 2015; 13:40-3. [PMID: 26425719 PMCID: PMC4563585 DOI: 10.1016/j.gore.2015.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/03/2015] [Accepted: 06/06/2015] [Indexed: 11/03/2022] Open
Abstract
Primary urethral cancer is a rare diagnosis, especially in females. This report presents the utilization of a palladium interstitial implant and a review of the retrospective data published on the management of female urethral cancer. Excellent local control and survival has been obtained with the use of a palladium interstitial implant in combination with external beam radiotherapy and concurrent chemotherapy. This modality represents a novel and effective way to treat primary urethral cancer in females.
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Affiliation(s)
- Hilary P Bagshaw
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Hospital, United States
| | - Ned L Williams
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Hospital, United States
| | - Y Jessica Huang
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Hospital, United States
| | - Jonathan D Tward
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Hospital, United States
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Hospital, United States
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11
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Keratin 9 is required for the structural integrity and terminal differentiation of the palmoplantar epidermis. J Invest Dermatol 2013; 134:754-763. [PMID: 23962810 PMCID: PMC3923277 DOI: 10.1038/jid.2013.356] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/21/2013] [Accepted: 06/27/2013] [Indexed: 11/12/2022]
Abstract
Keratin 9 (K9) is a type I intermediate filament protein whose expression is confined to the suprabasal layers of the palmoplantar epidermis. Although mutations in the K9 gene are known to cause epidermolytic palmoplantar keratoderma, a rare dominant-negative skin disorder, its functional significance is poorly understood. To gain insight into the physical requirement and importance of K9, we generated K9-deficient (Krt9−/−) mice. Here, we report that adult Krt9−/−mice develop calluses marked by hyperpigmentation that are exclusively localized to the stress-bearing footpads. Histological, immunohistochemical, and immunoblot analyses of these regions revealed hyperproliferation, impaired terminal differentiation, and abnormal expression of keratins K5, K14, and K2. Furthermore, the absence of K9 induces the stress-activated keratins K6 and K16. Importantly, mice heterozygous for the K9-null allele (Krt9+/−) show neither an overt nor histological phenotype, demonstrating that one Krt9 allele is sufficient for the developing normal palmoplantar epidermis. Together, our data demonstrate that complete ablation of K9 is not tolerable in vivo and that K9 is required for terminal differentiation and maintaining the mechanical integrity of palmoplantar epidermis.
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12
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Wang X, Bai P, Su H, Luo G, Zhong Z, Zhao X. Management of primary adenocarcinoma of the female urethra: Report of two cases and review of the literature. Oncol Lett 2012; 4:951-954. [PMID: 23162629 DOI: 10.3892/ol.2012.886] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/22/2012] [Indexed: 12/17/2022] Open
Abstract
Primary adenocarcinoma of the female urethra is rare and only a few retrospective cases have been published. The origin of urethral adenocarcinomas remains unclear. Certain authors have suggested that urethral adenocarcinomas in females originate at the periurethral Skene's glands. We report one case of urethral adenocarcinoma of the proximal urethra in a 44-year-old female who presented with painless urethral bleeding. Abdominal and pelvic CT scan with contrast and chest radiology were unremarkable. Biopsy of the mass revealed adenocarcinoma of the urethra. The patient was treated with partial urethrectomy and was free of disease for more than 5 years. We also present another rare case of mucinous adenocarcinoma in a 52-year-old female who complained of an enlarged urethral mass. Pelvic MRI revealed a tumor surrounding the whole urethra and bilateral inguinal lymph nodes. A puncture biopsy later revealed that the tumor was mucinous adenocarcinoma. Anterior pelvic exenteration with pelvic and bilateral lymph node dissection was performed and chemotherapy was administered. The patient was followed up for 12 months and did not experience local recurrence or distant metastasis. In conclusion, for the diagnosis of urethral cancer, a biopsy is necessary for any suspicious urethral lesions. MRI is recommended for tumor staging. Small, superficial, distal urethral tumors may be treated with excision of the distal urethra. For advanced female urethral cancer, a combination of chemotherapy, radiation therapy and surgery is recommended for optimal local and distant disease control. Regular follow-up is required in these patients.
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Affiliation(s)
- Xinjun Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011; ; Department of Urology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, P.R. China
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Chen LP, Lin SJ, Fu TY, Yu MS. Locally advanced female urethral adenocarcinoma of enteric origin: the role of adjuvant chemoradiation and brief review. Kaohsiung J Med Sci 2011; 27:150-4. [PMID: 21463838 DOI: 10.1016/j.kjms.2010.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 09/02/2010] [Indexed: 12/27/2022] Open
Abstract
Primary female urethral adenocarcinoma (FUA) is rare and has a poor prognosis. The common manifestations include urethrorrhagia, urinary frequency, dysuria, urethral obstructions, focal tenderness, and urinary tract infection. These symptoms are neither diagnostic nor pathognomonic; therefore, a delay in diagnosis and even a misdiagnosis is hardly uncommon. The histogenesis of FUAs may have derived from urethritis glandularis, Mullerian ducts, Skene's glands, or mixed origins. Tumors of different embryologic origins displayed heterogeneous pathological morphology and immunohistochemistical phenotypes. Because of its rarity and the lack of large-scale studies, there is no current consensus on the optimal treatment of urethral adenocarcinomas. Here, we report two cases of locally advanced FUA of enteric origin. They manifested as slightest warning symptoms of urinary tract infection and stress urinary incontinence, respectively. One patient died of disease progression 2 months after curative operation. The other patient underwent surgery followed by adjuvant irinotecan-containing chemoradiation, and the effect was at least modest. Hence, we recommend adjuvant chemoradiation in locally advanced FUA. Individualizing cancer care of chemoregimens in accordance with the tumor origins may probably be beneficial in FUAs.
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Affiliation(s)
- Ling-Ping Chen
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung, Taiwan
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14
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Reis LO, Ferreira F, Almeida M, Ferreira U. Urethral carcinoma: critical view on contemporary consecutive series. Med Oncol 2010; 28:1405-10. [PMID: 20596803 DOI: 10.1007/s12032-010-9609-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
Abstract
Urethral carcinoma is a rare cancer of the urinary tract. Although most cases are of squamous cell carcinomas, there are several reports in the literature about transitional cell carcinoma and adenocarcinomas whose origin remains controversial. While the diagnosis of this condition is essentially clinical, magnetic resonance imaging (MRI) is the examination of choice for its staging, and a pathological confirmation is still necessary. There is no consensus on the treatment of these tumors because of its low incidence. The following therapeutic options are currently available: surgical resection (often for small and distal urethral tumors); radiotherapy and chemotherapy, for larger tumors, seeking a functional preservation of the penis, bladder and/or vagina; or a combination of these therapies thereof in case of more extensive tumors. The classic treatment involves surgery aiming loco-regional disease control, and continent urinary derivation provides satisfactory functional results in cases of radical urethrectomy. Much still needs to be learned about urethral cancer, and molecular diagnostics tools and therapeutic targets are promissory. The key to better understanding urethral cancer is the pooling of data from a wide range of sources including international consortia.
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Affiliation(s)
- Leonardo Oliveira Reis
- Division of Urologic Oncology, University of Campinas (UNICAMP), R. Votorantim, 51, ap. 43, Campinas-SP, 13073-090, Brazil.
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15
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Reis LO, Billis A, Ferreira FT, Ikari LY, Stellini RF, Ferreira U. Female urethral carcinoma: evidences to origin from Skene's glands. Urol Oncol 2009; 29:218-23. [PMID: 19450996 DOI: 10.1016/j.urolonc.2009.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 03/02/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Urethral carcinoma is among the rarest neoplasias of the genitourinary tract and its origin is unclear. Prostate-specific antigen (PSA) is considered an evidence of origin from Skene's glands. We considered the origin from these glands in PSA negative cases. MATERIAL AND METHODS We studied 3 patients with urethral carcinoma surgically treated. The surgical specimens were examined including cytochemical and immunohistochemical stains. The possible origin of the tumors was based on a comparative study of normal Skene's glands from autopsies and noninvolved glands in periurethral tumors. RESULTS The gross findings and the microscopic examination of 2 adenocarcinomas, including the cytochemical and immunohistochemical studies, favor an origin from Skene's glands. CONCLUSIONS The origin from Skene's glands may be established in PSA negative cases. The establishment of this origin in a higher number of urethral carcinomas may have an impact on diagnostic and treatment strategies in the future.
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Affiliation(s)
- Leonardo Oliveira Reis
- Department of Urology, School of Medicine, University of Campinas (UNICAMP), Sao Paolo, Brazil.
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16
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Fletcher SG, Lemack GE. Benign masses of the female periurethral tissues and anterior vaginal wall. Curr Urol Rep 2008; 9:389-96. [PMID: 18702923 DOI: 10.1007/s11934-008-0067-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Due to their rarity, benign masses of the periurethral tissues and anterior vaginal wall are poorly understood. Arriving at the proper evaluation and treatment is challenging because many of these masses have similar presenting signs and symptoms, as well as overlapping differential diagnoses. The literature regarding these lesions mainly consists of level III evidence, mostly involving case reports and series. Clinical management has traditionally been based on established surgical principles and expert opinion. This review presents the pertinent embryologic and anatomic background for these benign masses, as well as other pertinent etiological processes. Furthermore, the most current evidence is reviewed regarding the differential diagnosis, evaluation, and treatment for each mass.
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17
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Custodio AMG, Santos FC, Campos SG, Vilamaior PS, Góes RM, Taboga SR. Aging Effects on the Mongolian Gerbil Female Prostate (Skene's Paraurethral Glands): Structural, Ultrastructural, Quantitative, and Hormonal Evaluations. Anat Rec (Hoboken) 2008; 291:463-74. [DOI: 10.1002/ar.20637] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kuroda N, Shiotsu T, Ohara M, Hirouchi T, Mizuno K, Miyazaki E. Female urethral adenocarcinoma with a heterogeneous phenotype. Case report. APMIS 2006; 114:314-8. [PMID: 16689832 DOI: 10.1111/j.1600-0463.2006.apm_345.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We here report a very rare case of female urethral adenocarcinoma. A 77-year-old woman presented with urinary retention. Cystoscopy showed a urethral tumor and the biopsy material showed adenocarcinoma. Macroscopically, the tumor measuring 3.0 x 3.0 x 2.4 cm was predominantly observed around the periurethral area on the proximal side. Histologically, patterns of columnar/mucinous adenocarcinoma, clear cell adenocarcinoma and papillary/micropapillary carcinoma were observed, but there was no evidence of a cribriform pattern. Immunohistochemically, neoplastic cells of at least one of three components were positive for CK7 and CK20 or CA125. We suggest that female urethral adenocarcinoma with a histologically and immunohistochemically heterogeneous phenotype may originate from cells within urethral or paraurethral tissue, such as urethritis glandularis or intestinal metaplastic epithelium and Mullerian tissue.
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Affiliation(s)
- N Kuroda
- Department of Pathology and Laboratory Medicine, Kochi Red Cross Hospital, Kochi, Japan
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Pongtippan A, Malpica A, Levenback C, Deavers MT, Silva EG. Skene's Gland Adenocarcinoma Resembling Prostatic Adenocarcinoma. Int J Gynecol Pathol 2004; 23:71-4. [PMID: 14668555 DOI: 10.1097/01.pgp.0000101144.79462.39] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An 88-year-old woman presented with gross hematuria and a 3-cm periurethral mass. Biopsy revealed an adenocarcinoma resembling prostatic adenocarcinoma; the tumor cells were positive for keratin and prostate-specific antigen. The serum level of prostate-specific antigen was elevated; the carcinoembryonic antigen and CA-125 serum levels were normal. One year after external beam radiotherapy, the patient is without evidence of disease. This is the sixth case of a urethral prostatic-type adenocarcinoma, tumors that are most likely of Skene's gland origin.
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Affiliation(s)
- Atcharaporn Pongtippan
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA
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20
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Abstract
A 69-year-old woman presented with difficulty in urination and bloody fluid discharge from the urethra. Based upon a diagnosis of primary urethral carcinoma, she underwent total cysto-urethrectomy and hysterectomy with pelvic lymph node dissection and urinary diversion of ileal conduit. Microscopically, the tumor was composed of mucinous adenocarcinoma and signet ring cell carcinoma. There was no recurrence 17 months after the surgery.
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Affiliation(s)
- K Suzuki
- Department of Urology, Jichi Medical School, Tochigi, Japan.
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21
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Yamaguchi S, Hashimoto H, Kaneko S, Tokunaka S, Yachiku S. Secondary mucinous adenocarcinoma of the prostate in a patient with ulcerative colitis. Urol Int 1993; 50:231-3. [PMID: 8389496 DOI: 10.1159/000282492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Herein we report a rare case of prostatic invasion of rectal carcinoma in a patient with ulcerative colitis. Malignant transformation is a well-known complication of long-standing ulcerative colitis. Mucinous adenocarcinoma, with positive carcinoembryonic antigen and negative prostate-specific antigen, strongly suggested the rectal origin of the tumor.
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Affiliation(s)
- S Yamaguchi
- Department of Urology, Asahikawa Medical College, Japan
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