Adenocarcinoma arising in female urethral diverticulum

Urethral diverticulum carcinoma in females-a case series and review of the English and Japanese literature

The aims of our study were to describe our case series of three urethral diverticulum carcinomas (UDC) in women and to review the literature on UDC in females to determine patient characteristics, presenting symptoms and outcomes along with optimal investigations and treatment modalities. A literature search was performed utilizing Medline, EMBASE and the Cochrane library for all papers including case reports on UDC in women published to date. The results along with those of our three cases are detailed. A total of 126 cases of UDC in women have been reported; 75% adenocarcinoma (Adenoca), 15% transitional cell carcinoma (TCC) and 10% squamous cell carcinoma (SCC). Median age at presentation was 53 years (range, 14-81 years). The commonest presenting symptoms were bleeding and retention. Cystoscopy, MRI and trans-urethral biopsy were the commonest methods of diagnosis. Treatment was radiotherapy +/- chemotherapy alone in 21%, local excision +/- radiotherapy in 44%, urethrectomy in 3% and anterior exenteration +/- radiotherapy in 32%. At last follow-up 63% were alive and well, 10% were alive with recurrent cancer and 25% had died from their disease. UDC is rare in women. It is predominantly adenocarcinoma. There is no established treatment and survival is at best moderate. An international registry and consensus on management is needed if this is to be improved.

Clear Cell Adenocarcinoma of the Urethra in Women: Distinctive MRI Findings for Differentiation From Nonadenocarcinoma and Non-Clear Cell Adenocarcinoma of the Urethra

OBJECTIVE

The purpose of this study is to evaluate the MRI findings differentiating clear cell adenocarcinoma of the urethra (CCAU) from nonadenocarcinoma of the urethra (NACU) and non-clear cell adenocarcinoma of the urethra (NCCAU) in women.

MATERIALS AND METHODS

Six women with pathologically proven CCAU, six women with pathologically confirmed NACU (two squamous cell carcinomas and four transitional cell carcinomas), and nine women with NCCAU underwent preoperative MRI. The MRI findings for CCAU, NACU, and NCCAU were reviewed by a radiologist who was blinded to the histopathologic findings and were compared using the Mann-Whitney U test and the Fisher exact test.

RESULTS

CCAU was shorter in height than NACU (3.4 cm vs 5.5 cm; p = 0.020) and also had a smaller height-to-width ratio than NACU (0.85 vs 1.51; p < 0.001) and NCCAU (0.85 vs 1.48; p = 0.002). The proportion of preserved urethra in CCAU (67%) was larger than that in either NACU (9%; p < 0.001) or NCCAU (22%; p < 0.001). All cases of CCAU originated within a diverticulum, whereas none of the cases of NACU and only one NCCAU originated in a diverticulum. Intratumoral septation was more frequently observed in CCAU (100%) than in NACU (16.6%; p = 0.015) or NCCAU (11.1%; p = 0.001).

CONCLUSION

MRI findings for CCAU were significantly distinctive, compared with findings for NACU and NCCAU. All cases of CCAU were associated with a urethral diverticulum, and CCAU had a lower height-to-width ratio, more frequent intratumoral septation, and greater preservation of normal urethra than did NACU and NCCAU.

Clear cell carcinoma of female urethral diverticulum--a case report

Primary malignancies of female urethral diverticulum are rare. A well-documented female patient with primary clear cell carcinoma of the urethral diverticulum is presented here. A 65-year-old woman presented with frequency and voiding difficulty for 2 months. Physical examination showed a 4-cm mass protruding from anterior vaginal wall. Intravenous urography, magnetic resonance imaging, and cystoscopy showed a polypoid mass in urethral diverticulum. She then underwent anterior exenteration with ileal conduit diversion and urethrectomy. Pathology confirmed the diagnosis of clear cell adenocarcinoma with bladder neck invasion. She had no disease recurrence at 2-year follow-up. Careful clinical examination and image studies are helpful in making the preoperative diagnosis for the rare disease. Early radical surgery can achieve better survival.

Urinary retention caused by adenocarcinoma arising in recurrent urethral diverticulum

We present a case of adenocarcinoma arising in a urethral diverticulum. A 71-year-old woman presented with urinary retention and a mass in the anterior vaginal wall. A biopsy was performed and revealed adenocarcinoma. Anterior pelvic exenteration with continent urinary diversion was performed followed by adjuvant radiation therapy as the tumor was large and poorly differentiated. She developed stomal stenosis and underwent stomal revision. The patient has done well since, with no evidence of recurrence at 1-year follow-up at the time of this report.

Conservative surgical therapy for penile and urethral carcinoma

OBJECTIVES

Invasive penile and urethral tumors are traditionally treated with aggressive excision that requires involved organ and adjacent organ sacrifice. An alternative approach seeks to completely excise the tumor with adequate margins while preserving form and function of the organ. We present 6 patients who underwent such organ-sparing surgery.

METHODS

Six selected cases (4 penile and 2 urethral) are presented with operative photographs and pertinent data.

RESULTS

Three distal tumors of the penis were treated with excision limited to the glans with histopathologic findings of verrucous carcinoma, melanoma, and angiosarcoma. One patient with squamous cell carcinoma of the distal shaft refused partial penectomy and underwent a local wedge resection. A patient with locally advanced bulbourethral transitional cell carcinoma (TCC) refused cystourethrectomy and underwent an anterior urethrectomy and perineal urethrostomy. A 48-year-old woman with an adenocarcinoma contained in a very distal urethral diverticulum underwent simple diverticulectomy and excision of distal urethra. Postoperative voiding and sexual function were well preserved. Follow-up was 12 to 48 months. The patient with angiosarcoma died of lung metastases at 48 months with no local disease, and the patient with bulbourethral TCC developed pelvic disease at 12 months with no local recurrence and died of metastases at 25 months.

CONCLUSIONS

Organ-sparing surgery is appropriate in selected patients on the basis of stage and location, high risk of distant failure, and patient disposition. Close follow-up is necessary. Comanagement with reconstructive and oncologic specialists optimizes results and outcomes.

Carcinoma in female urethral diverticulum: case reports and review of management

We report on 4 women ages 31 to 65 years with adenocarcinoma of urethral diverticulum. One patient presented with metastatic disease and died after refusing post-radiation surgery. The other 3 women were without evidence of disease 9 to 44 months after diverticulectomy with radiation (1) or radical surgery (2). Review of our 4 cases and 64 cases documented in the literature showed that irritative voiding symptoms and hematuria were the most common findings. A palpable urethral mass was described in only 56% of reported cases but was observed in all of our patients, with the smallest mass measuring 2 x 2 cm. Urethroscopy with biopsy is the most important diagnostic test. Aggressive treatment is appropriate in most patients, since local recurrence has been documented in 44% of those treated by diverticulectomy and/or radiation.

Urethral diverticular carcinoma

BACKGROUND

Urethral diverticular carcinoma is an unusual finding in a urologic lesion commonly found in female patients.

METHODS

This report presents 6 new cases and reviews the other 53 cases in the English literature.

RESULTS

Adenocarcinoma occurs more frequently than transitional and squamous cell cancers combined.

CONCLUSION

The prognosis of the former is more favorable. In general, radical therapy is recommended. However, in some instances of localized disease, and with careful follow-up, a more conservative approach might be attempted.

Adenocarcinoma in a female urethral diverticulum

Carcinoma occurring within a diverticulum of the female urethra is an exceedingly rare disease for which the treatment is ill-defined. We present here the first reported case of this condition from Australasia and review some of the recommendations for treatment.

Clear cell adenocarcinoma of the urethra: evidence for origin within paraurethral ducts

We report a case of clear cell adenocarcinoma arising in a paraurethral duct treated by anterior pelvic exenteration. Immunohistochemical stains for prostate specific acid phosphatase and prostate specific antigen were positive in the primary tumor and regional metastases. Focal positive staining also was noted in normal paraurethral duct epithelium. Our observations suggest that clear cell adenocarcinoma arises from the female paraurethral ducts, rather than embryonic remnants. These ducts appear to be homologous to the prostate and in some cases may be misinterpreted as urethral diverticula.

Diverticulum of the female urethral roof managed endoscopically

We report a rare case of a diverticulum located along and draining into the roof of the urethra in a woman. This diverticulum was managed successfully endoscopically with a pediatric resectoscope. The pathophysiology of this unusual lesion is discussed, as is the rationale for endoscopic management.