Urethral adenocarcinoma (possibly originating in the glands of Littre)

Sonographic features of penile-gland lithiasis

A 52-year-old man presented with a small, red, tender swelling near the penile frenulum at the lower edge of the base of the glans. Lower urinary tract symptoms were absent. Ultrasonography revealed a stone lodged in the distalmost portion of the glands of Littre. Combined with a good knowledge of penile anatomy, use of this simple imaging tool allows reliable diagnosis of even the rarest cases of penile pathology.

Experience with Primary Urethral Carcinoma from the Blackfoot Disease-Endemic Area of South Taiwan: Increased Frequency of Bulbomembranous Adenocarcinoma?

OBJECTIVES

To describe and compare primary urethral carcinomas in South Taiwan with those in the USA and to explore the influence of chronic arsenic exposure.

METHODS

From 1988 to 2001, there were 21 pathologically proven primary urethral carcinomas diagnosed and treated at our hospital (14 males, 7 females). Seven of 14 male patients were chronically exposed to arsenic in drinking water for an average of 23 years. We compared our cases to three studies in the USA (80 males, 179 females), and analyzed the influence of chronic arsenic exposure by onset age, histology, staging, and outcome.

RESULTS

Male patients with localized tumors had better survival compared to those with advanced tumors (p = 0.0045 in males, p = 0.07 in females). In comparison to the three studies in the USA, there was an unusual higher frequency of bulbomembranous adenocarcinoma at our center (43 vs. 18%, 2 and 0%, respectively, p < 0.0001), particularly among those with chronic arsenic exposure (73 vs. 14%, p = 0.031).

CONCLUSIONS

In South Taiwan, there was a high frequency of bulbomembranous urethral adenocarcinoma, which might be associated with chronic arsenic exposure. Although the implications of such an observation are minimal owing to its rarity, it is worth exploring.

Abdominoperineal excision of male lower urinary tract for synchronous adenocarcinoma of urethra and urinary bladder

Urethral adenocarcinoma is the least common histologic subtype of a rare primary carcinoma of the male urethra. Its site of origin remains speculative. The scarcity of reported cases in the literature makes it difficult to define the optimal management. This report is of a 40-year-old morbidly obese man with synchronous adenocarcinoma of the bulbar urethra and bladder, treated surgically by en bloc abdominoperineal penoprostatocystectomy. The pleural recurrence, after a disease-free period of 2 years, responded well to platinum-docetaxel-based systemic chemotherapy. Synchronous occurrence of adenocarcinoma of the urethra and bladder has not been previously reported. This case also highlights the possible role of upcoming adjuvant chemotherapeutic agents.

[Primary adenocarcinoma of the male urethra. A case report]

Primary adenocarcinoma of the male urethra is very uncommon, accounts for 5% of primary urethral cancers. All types of urethral carcinomas account for less than 1% of urinary malignancies in man. The prognosis remains poor despite the wide surgical treatment. The place of chemotherapy combined with radiotherapy must be defined by other studies. We report a case of primary locally advanced adenocarcinoma arising in the bulbo-membranous urethra. The patient was 29 years old, without any previous history of venerian disease. He was treated by combined external beam radiotherapy (total dose 67Gy) and chemotherapy (Cisplatinum). A marked reduction of tumor volume has been noted but the patient died because of the appearance of bone metastasis which failed to the systemic therapy.

Surface adenosquamous carcinoma of the penis. A report of three cases

Three patients, aged 37, 72, and 74 years, with adenosquamous carcinoma of the penis are described. The duration of disease was 6, 9, and 144 months, respectively. Grossly a firm, white-gray granular exophytic mass was noted (7.6 cm average diameter). Microscopically, a mixed carcinoma showing squamous and glandular elements was present; the squamous component predominated. In two cases the adenocarcinoma was located in the perimeatal area of the glans. The periurethral glands were not involved. The glandular foci were discrete and had minimal admixture with the squamous carcinoma. Mucin material was present in the lumina, apical border, and cytoplasm. Immunohistochemically, cells showed positivity for carcinoembryonic antigen in glandular areas. The squamous cell carcinomas were of the "warty" variant in two cases and of the usual squamous cell type in the other case. In one patient, metastatic adenosquamous carcinoma was noted in one inguinal node and showed mucin secretion. This patient is alive and well 102 months after diagnosis. Another patient is alive with no evidence of disease 12 months after surgery, and the third was lost to follow-up. Adenosquamous carcinomas of the penis are unusual neoplasms probably originating in penile surface epithelium and in embryologically misplaced mucus glands of the perimeatal region of glans mucosa.

Colonic-type adenocarcinoma of male urethra

A case of a rare primary urethral carcinoma is presented. The histochemical characteristics of this tumor are identical to those of colon tumors. The patient was treated with segmental urethrectomy.

Penile nodule in a young adult

A 20 year old male presented with a nodule, 1.25 cm x 1 cm, on the ventral aspect of the foreskin of his penis. The nodule was excised by circumcision. On histology it was found to be a multiloculated cyst located in the dermis of the prepuce. It contained eosinophilic material and was lined by pseudostratified columnar epithelium. There was no evidence of inflammation or malignancy in any of the sections of this median raphe cyst. The aetiology of such cysts is discussed in addition to a review of the literature.

Adenocarcinoma of the male urethra with associated nephrogenic metaplasia. Case report and review of the literature

Nephrogenic metaplasia is an uncommon sequela of chronic bladder irritation. The case described herein represents the second reported in the bulbomembranous urethra of the male. Important questions are raised regarding the premalignant potential of nephrogenic metaplasia. A review of the literature on adenocarcinoma of the male urethra and also of nephrogenic metaplasia of the bladder and urethra is presented.

Papillary adenocarcinoma of the male urethra. Case report and review of the literature

Mucinous papillary adenocarcinoma of the bulbous urethra developed in a 40-year-old man with congenital stricture. The tumor appeared as a localized polypoid exophytic mass without evidence of submucosal invasion (Stage 0). The tumor was determined not to be of prostatic origin clinically and by absence of immunoperoxidase staining for prostatic acid phosphatase, prostate specific antigen, and carcinoembryonic antigen. Surgical resection of the urethra revealed extensive squamous and glandular metaplasia (urethritis glandularis) in association with the neoplasm. The mucosa displayed a spectrum of epithelial changes varying from dysplasia to carcinoma in situ, in confirmation of the urethral origin of the tumor. These observations emphasize the close association of metaplastic proliferative lesions and malignancy in the lower urinary tract.

Carcinoma of deep male urethra

Carcinoma of the deep male urethra is a rare disease. Conservative measures yielding dismal outcomes were standard until 1957, with the report of an 80 per cent five-year survival rate after radical surgery. To assess the value of this surgery, we reviewed all cases of carcinoma of the deep male urethra managed at UCLA Medical Center and its affiliated hospitals between 1952 and 1980. Of the patients managed with radical surgery, 1 died of a myocardial infarction between staged surgical procedures, and 5 died of their disease between twelve and fifty-two months postoperatively (mean survival, 26 months). There were 2 long-term disease-free survivors, yielding a survival rate of 25 per cent. We have also compiled the results of all major series dealing with deep urethral carcinoma published subsequent to the 1957 report. This review of the literature supports the concept that radical extirpative surgery is mandatory in the management of carcinoma of the deep male urethra.

Villous adenocarcinoma of the male urethra

We report on 2 men with multifocal papillary adenocarcinoma arising in the bulbous urethra proximal to a urethral stricture. Histologically, the tumors appeared similar to villous adenocarcinomas of the colon and rectum. Both patients were treated with segmental urethrectomy. Villous adenocarcinoma of the male urethra is a distinctive clinicopathologic entity. Although uncommon it should be added to squamous cell carcinoma and transitional cell carcinoma on the list of tumor types causing cancer of the male urethra.

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.

Inflammation of the periurethral glands of Littre simulating tumor

A young man presented with a subfrenular nodule of the penis that proved to be ectasia and chronic inflammation of the periurethral glands of Littre. Pathological processes involving these glands are rare but must be considered in the differential diagnosis of penile or urethral lesions.

Mucoid cysts of the penile skin

A study of 28 patients with mucoid cysts of the penile skin is reported. The lesions were seldom diagnosed correctly, either clinically or pathologically. The distinctive histologic features of the cysts include a lining of stratified columnar epithelium, often associated with intra-epithelial mucous cells and/or mucous glands. These cysts most likely arise from ectopic urethral mucosa sequestered in the penile skin during embryologic development.