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Kurniawan J, Seputra KP, Daryanto B, Anita KW. Primary urethral carcinoma in female: An extremely rare case series at a single tertiary referral hospital and literature review. Int J Surg Case Rep 2024; 121:109993. [PMID: 38972106 PMCID: PMC11277758 DOI: 10.1016/j.ijscr.2024.109993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary urethral carcinoma (PUC) is exceedingly uncommon and accounts for 0.02 % of all female cancers and <1 % of female genitourinary tract malignancy. PUC in female usually presents late with a higher disease stage and, hence, has higher cancer-specific mortality. Due to its rarity, the current recommendation for the management of PUC is still unclear. CASE PRESENTATION This study reports two rare cases of 59-year-old and 65-year-old women with PUC, presenting with chief complaint of hematuria. Urethrocystoscopy and biopsy were performed. Pathology results revealed mucinous adenocarcinoma (AC) and urothelial carcinoma (UC) of the urethra, respectively. Radiological imaging was conducted for staging. Both were diagnosed with cT4N2M0. The first patient underwent anterior pelvic exenteration with bilateral ureterocutaneoustomy (UCS), while the second patient received cisplatin-based chemotherapy before the surgery. Radiological follow-up was planned 3 months after the surgery. CLINICAL DISCUSSION Both mucinous AC and UC are considered incredibly unusual subtypes, with no defined treatment guidelines. Anterior exenteration with or without neoadjuvant chemotherapy may be opted for advanced PUC affecting the proximal urethra and adjacent organs. Following the previous studies, in this case series, both patients (locally advanced) underwent anterior exenteration. Additionally, the UC subtype received multimodal treatment with neoadjuvant chemotherapy which was shown to improve overall survival. CONCLUSION In conclusion, PUC is extremely rare, and the choice of management remained various. Long-term follow-up for these patients is mandatory to improve understanding of this incredibly uncommon disease.
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Affiliation(s)
- Jemmy Kurniawan
- Department of Urology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, East Java, Indonesia
| | - Kurnia Penta Seputra
- Department of Urology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, East Java, Indonesia; Genito Urinary Research Group, Faculty of Medicine, Universitas Brawijaya, Indonesia.
| | - Besut Daryanto
- Department of Urology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, East Java, Indonesia; Genito Urinary Research Group, Faculty of Medicine, Universitas Brawijaya, Indonesia
| | - Kenty Wantri Anita
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, East Java, Indonesia
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Neuville P, Murez T, Savoie PH, Rocher L, Fléchon A, Ferretti L, Van Hove A, Branger N, Camparo P, Rouprêt M. Primary urethral carcinoma: Recommendations of the oncology committee of the French Urology Association. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102606. [PMID: 38437949 DOI: 10.1016/j.fjurol.2024.102606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Primary urethral carcinoma (PUC) is defined as a tumor process arising within the urethra, with no history of other urinary tract localization or synchronous tumor of the urinary tract. The most common histological types are urothelial carcinoma (UC), squamous cell carcinoma (SCC) and adenocarcinoma (AC). In men, UC predominates, while AC is rare. In women, AC affects around one in two patients, while EC and UC are equally divided between the remaining cases. Diagnosis is often delayed, and requires endoscopic examination with biopsies. MRI is the gold standard for local staging. FDG-PET scan can help in cases of doubt about regional or distant extension. The prognosis remains unfavorable despite aggressive surgical treatment. Multimodal management combining surgery, radiotherapy and chemotherapy appears to improve prognosis in severe forms.
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Affiliation(s)
- Paul Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - Thibaut Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Pierre Henri Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre d'urologie UROVAR, polyclinique les Fleurs, 332, avenue Frédéric-Mistral, 83190 Ollioules, France
| | - Laurence Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Aude Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Ludovic Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France; Service d'urologie, MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - Antoine Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - Nicolas Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France
| | - Philippe Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 11, allée de l'Échauguette, 80000 Amiens, France
| | - Morgan Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, 75013 Paris, France
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Ruas JPP, Andrade TV, Scopacasa EC, Prado FG, Horwacz M, Mello LFC, Abrahão RF, Filho JEAP. Urethral Mucinosous Adenocarcinoma in a Female Patient-A Case Report. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00205. [PMID: 38624034 DOI: 10.1097/spv.0000000000001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- João Pedro Paulino Ruas
- From the Department of Urogynecology and Reconstructive Urology Surgery, Federal Hospital of Ipanema, Rio de Janeiro, Brazil
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Zheng Y, Xue YY, Zhao YQ, Chen Y, Li ZP. Disitamab Vedotin plus anti-PD-1 antibody show good efficacy in refractory primary urethral cancer with low HER2 expression: a case report. Front Immunol 2023; 14:1254812. [PMID: 37901233 PMCID: PMC10601644 DOI: 10.3389/fimmu.2023.1254812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Primary urethral carcinoma (PUC) has a low incidence, but with high aggressiveness. Most of the patients are found in late stage, with poor prognosis. At present, chemotherapy is still the main treatment for metastatic PUC, but it has limited effect. Here, we report a case of metastatic PUC with low HER2 expression that developed disease progression after multiline therapy including chemotherapy, programmed death-1 (PD-1) inhibitors and multi-targeted receptor tyrosine kinase (RTK) inhibitor. After receiving Disitamab Vedotin(a novel antibody drug conjugate, ADC) and toripalimab (a PD-1 inhibitor), the patient achieved persistent PR, and the PFS exceeded 12 months up to now. Our report indicates that, despite the patient of metastatic PUC has low expression of HER2, it is still possible to benefit from Disitamab Vedotin combined with PD-1 inhibitor, which may reverse the drug resistance of PD-1 inhibitor and chemotherapy to a certain extent. But larger sample studies are needed to determine the efficacy of this treatment strategy and its impact on survival.
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Affiliation(s)
- Yue Zheng
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
- Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yin-Yin Xue
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ya-Qin Zhao
- Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Division of Abdominal Tumor Multimodality Treatment, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ye Chen
- Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Division of Abdominal Tumor Multimodality Treatment, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Ping Li
- Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Division of Abdominal Tumor Multimodality Treatment, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kochergin M, Fahmy O, Asimakopoulos AD, Gakis G. Role of inguinal and pelvic lymph node dissection for primary urethral carcinoma: a systematic review. Curr Opin Urol 2023; 33:288-293. [PMID: 37158221 DOI: 10.1097/mou.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE OF REVIEW Primary urethral carcinoma (PUC) is a rare urologic tumor. There is limited evidence on this entity. This review summarizes the existing evidence on lymph node dissection (LND) in patients with PUC. RECENT FINDINGS We performed a systematic search of the PubMed, EMBASE, and Web of Science databases to evaluate the impact of inguinal and pelvic LND on the oncological outcomes of PUC and to identify indications for this procedure. RESULTS Three studies met the inclusion criteria. The cancer detection rate in clinically nonpalpable inguinal lymph node (cN0) was 9% in men and 25% in women. In clinically palpable lymph node (cN+), the malignancy rate was 84% and 50% in men and women, respectively. Overall cancer detection rate in pelvic lymph nodes in patients with cN0 was 29%. Based on tumor stage, the detection rate was 11% in cT1-2 N0 and 37% in cT3-4 N0. Nodal disease was associated with higher recurrence and worse survival. Pelvic LND seems to improve overall survival for patients with LND regardless of the location or stage of lymph nodes. Inguinal LND improved overall survival only in patients with palpable lymph nodes. Inguinal LND had no survival benefit in patients with nonpalpable lymph nodes. SUMMARY The available, albeit scarce, data suggest that inguinal LND derives the highest benefit in women and in patients with palpable inguinal nodes, whereas the benefit of pelvic LND seems to be more pronounced across all stages of invasive PUC. Prospective studies are urgently needed to further address the prognostic benefit of locoregional LND in PUC.
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Affiliation(s)
- Maxim Kochergin
- Department of Urology and Neurourology, BG Unfallkrankenhaus Berlin, Berlin, Germany
| | - Omar Fahmy
- Department of Urology, Universiti Putra Malaysia (UPM), Selangor, Malaysia
| | | | - Georgios Gakis
- University Clinic and Polyclinic of Urology, University Hospital of Halle, Halle (Saale), Germany
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Lagarde-Lenon MS, Aron M. Reprint of: Female Urethral Carcinoma: A contemporary review of the clinicopathologic features, with emphasis on the histo-anatomic landmarks and potential staging issues. Hum Pathol 2023; 133:126-135. [PMID: 36894368 DOI: 10.1016/j.humpath.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 03/09/2023]
Abstract
Primary female urethral carcinoma (PUC-F) accounts for less than 1% of all genitourinary malignancies and comprises a histologically diverse group of tumors that are usually associated with poor prognosis. The carcinomas documented at this site include adenocarcinoma (clear cell adenocarcinoma, columnar cell carcinoma, and Skene gland adenocarcinoma), urothelial carcinoma (UCa), and squamous cell carcinoma (SCC). Recent studies have shown adenocarcinomas to be the most common type of primary urethral carcinoma in females. As most of the urethral carcinomas morphologically resemble carcinomas arising from surrounding pelvic organs or metastases, these should be ruled out before making the diagnosis of PUC-F. These tumors are currently staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. However, the AJCC system has limitations, including the staging of tumors involving the anterior wall of the urethra. Staging systems like the recently proposed histology-based female urethral carcinoma staging system (UCS) takes into account the unique histological landmarks of the female urethra to better stratify pT2 and pT3 tumors into prognostic groups, that correlate with clinical outcomes including recurrence rates, disease-specific survival and overall survival. Further larger multi-institutional cohorts are however required to validate the results of this staging system. There is very limited information regarding the molecular profiling of PUC-F. Thirty-one percent of clear cell adenocarcinomas have been reported to show PIK3CA alterations, whereas 15% of adenocarcinomas show PTEN mutations. Higher tumor mutational burden and PD-L1 staining have been reported in UCa and SCC. Although multimodality treatment is usually recommended in locally advanced and metastatic disease, the role of immunotherapy and targeted therapy is promising in select PUC-F cases.
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Affiliation(s)
- Maria Sarah Lagarde-Lenon
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA
| | - Manju Aron
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA.
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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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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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Lagarde-Lenon MS, Aron M. Female urethral carcinoma: a contemporary review of the clinicopathologic features, with emphasis on the histoanatomic landmarks and potential staging issues. Hum Pathol 2022; 129:71-80. [PMID: 36037997 DOI: 10.1016/j.humpath.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Primary female urethral carcinoma (PUC-F) accounts for less than 1% of all genitourinary malignancies and comprises a histologically diverse group of tumors that are usually associated with poor prognosis. The carcinomas documented at this site include adenocarcinoma (clear cell adenocarcinoma, columnar cell carcinoma, and Skene gland adenocarcinoma), urothelial carcinoma (UCa), and squamous cell carcinoma (SCC). Recent studies have shown adenocarcinomas to be the most common type of primary urethral carcinoma in females. As most of the urethral carcinomas morphologically resemble carcinomas arising from surrounding pelvic organs or metastases, these should be ruled out before making the diagnosis of PUC-F. These tumors are currently staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. However, the AJCC system has limitations, including the staging of tumors involving the anterior wall of the urethra. Staging systems like the recently proposed histology-based female urethral carcinoma staging system (UCS) takes into account the unique histological landmarks of the female urethra to better stratify pT2 and pT3 tumors into prognostic groups, that correlate with clinical outcomes including recurrence rates, disease-specific and overall survival. Further larger multi-institutional cohorts are however required to validate the results of this staging system. There is very limited information regarding the molecular profiling of PUC-F. Thirty-one percent of clear cell adenocarcinomas have been reported to show PIK3CA alterations, whereas 15% of adenocarcinomas show PTEN mutations. Higher tumor mutational burden and PD-L1 staining have been reported in UCa and SCC. Although multimodality treatment is usually recommended in locally advanced and metastatic disease, the role of immunotherapy and targeted therapy is promising in select PUC-F cases.
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Affiliation(s)
- Maria Sarah Lagarde-Lenon
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA
| | - Manju Aron
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA.
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Bai H, Han H, Wang F, Shi H. Chemotherapy combined with immunotherapy in primary female urethral squamous cell carcinoma: a case report. J Int Med Res 2022; 50:3000605221132418. [PMID: 36281031 PMCID: PMC9608069 DOI: 10.1177/03000605221132418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Primary female urethral carcinomas are uncommon and have a low morbidity rate. Most of these patients have advanced illness with high invasion and a poor prognosis. There is no standard treatment, and multimodal therapy is recommended. The use of radiotherapy and chemotherapy were mostly reported in previous studies on advanced female urethral squamous cell carcinoma. We report that chemotherapy combined with a programmed death-1 (PD-1) inhibitor was effective in treating metastatic female urethral squamous cell carcinoma. During four cycles, we used systemic chemotherapy of albumin-paclitaxel + carboplatin in combination with a PD-1 inhibitor (toripalimab 240 mg) every 3 weeks, and a complete response was achieved. We performed a genetic test on the patient who had a tumor mutation burden of 5.7 mutations/Mb, tumor proportion score of 20%, and combined positive score of 20% (22C3). No recurrence or distant metastasis was found after 20 months of follow-up. In conclusion, in patients with positive PD-1 ligand 1 expression in primary female urethral squamous cell carcinoma, chemotherapy combined with PD-1 inhibitors may be effective. Larger sample studies are required to determine PD-1 ligand 1 expression and the curative effect of PD-1 inhibitors, as well as their effect on survival.
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Affiliation(s)
- Hongsong Bai
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing,100021, China,Department of Urology, Cancer Hospital of HuanXing Chaoyang District Beijing, Beijing 100122, China
| | - Huifu Han
- Department of Radiology, Cancer Hospital of HuanXing Chaoyang District Beijing, Beijing 100122, China
| | - Fan Wang
- Department of Radiology, Cancer Hospital of HuanXing Chaoyang District Beijing, Beijing 100122, China
| | - Hongzhe Shi
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing,100021, China,Hongzhe Shi, Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
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Su HC, Zhu Y, Ye DW. A brief review on the diagnostic and therapeutic principles of primary urethral cancer. Asian J Urol 2022; 9:423-429. [PMID: 36381601 PMCID: PMC9643286 DOI: 10.1016/j.ajur.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/19/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Primary urethral carcinoma (PUC) is a rare malignant carcinoma but with limited therapeutic options. This review aims to provide an overview of the current strategies on this patient settings. Methods Recent literature ranging from January 1987 and December 2021 was assessed through PubMed search to assess the diagnostic and therapeutic principles of PUC. Results A complete of examination including cystoscopy, imaging, and biopsy should be conducted for these patients. Once diagnosed, the clinical decision of PUC should be made according to the tumor location, pathological pattern, and extent of the tumor. For patients with superficial and distal urethral lesions, organ sparing approaches or radical reconstructive procedures can be utilized. While for more advanced disease or nodal involvement, an optimal multimodal treatment strategy consisted of surgery and radiochemotherapy should be adopted. For patients with urothelial carcinoma of the prostate, the management including transurethral resection of the prostate followed by bacille Calmette-Guerin or radical cystoprostatectomy should depend on the infiltration depth of PUC. Conclusion A complete of examination is important for the diagnosis of PUC. The management of PUC should be determined by the location, pathological pattern, and extent of the tumor. More multi-institutional collaborations should be held to investigate better treatment modalities for PUC.
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Lee W, Yu J, Lee J, Kim YS, Hong B. Clinical features and oncological outcomes of primary female urethral cancer. J Surg Oncol 2022; 125:907-915. [DOI: 10.1002/jso.26790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Wonchul Lee
- Department of Urology Hallym University Dongtan Sacred Heart Hospital Hwaseong Korea
| | - Jesang Yu
- Department of Radiation Oncology Kosin University Gospel Hospital Busan Korea
| | - Jae‐Lyun Lee
- Department of Oncology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation. BMC Cancer 2021; 21:857. [PMID: 34315433 PMCID: PMC8314574 DOI: 10.1186/s12885-021-08603-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Primary urethral carcinoma (PUC) is a rare genitourinary malignancy with a relatively poor prognosis. The aim of this study was to examine the impact of surgery on survival of patients diagnosed with PUC. Methods A total of 1544 PUC patients diagnosed between 2004 and 2016 were identified based on the SEER database. The Kaplan-Meier estimate and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). The multivariate Cox regression model and competing risks regression model were used to identify independent risk factors of OS and cancer-specific survival (CSS). Results The 5-yr OS was significantly better in patients who received either local therapy (39.8%) or radical surgery (44.7%) compared to patients receiving no surgery of the primary site (21.5%) (p < 0.001). Both local therapy and radical surgery were each independently associated with decreased CSM, with predicted 5-yr cumulative incidence of 45.4 and 43.3%, respectively, compared to 64.7% for patients receiving no surgery of the primary site (p < 0.001). Multivariate analyses demonstrated that primary site surgery was independently associated with better OS (local therapy, p = 0.037; radical surgery, p < 0.001) and decreased CSM (p = 0.003). Similar results were noted regardless of age, sex, T stage, N stage, and AJCC prognostic groups based on subgroup analysis. However, patients with M1 disease who underwent primary site surgery did not exhibit any survival benefit. Conclusion Surgery for the primary tumor conferred a survival advantage in non-metastatic PUC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08603-z.
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Farrell MR, Xu JT, Vanni AJ. Current Perspectives on the Diagnosis and Management of Primary Urethral Cancer: A Systematic Review. Res Rep Urol 2021; 13:325-334. [PMID: 34104638 PMCID: PMC8180270 DOI: 10.2147/rru.s264720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Primary urethral cancer (PUC) is a rare but highly aggressive malignancy that causes malignant urethral obstruction. We conducted a literature review using PubMed to identify original research studies that assessed the diagnosis and management of primary urethral cancer. PUC affects men more than women, is more common in African Americans than Caucasians, and is associated with history of chronic inflammation and irritation of the urinary tract. Patients suspected of PUC should undergo a complete work-up including cystoscopy, magnetic resonance imaging, and biopsy. In men and women, surgical monotherapy ranging from organ-sparing to more radical reconstructive procedures has adequate survival rates for early stage PUC and has been shown to be similarly as effective as radiation monotherapy, while multimodal therapy has become the standard of treatment for advanced stage PUC. Salvage surgery or radiation therapy has been linked with increased survival rates. Nodal involvement at the time of diagnosis is a negative prognosticator and should be treated with multimodal therapy. Further prospective studies with greater sample sizes and standardized clinical trials would allow for greater consistency in evaluating the different treatment modalities for PUC.
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Affiliation(s)
- M Ryan Farrell
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Jonathan T Xu
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Alex J Vanni
- Center for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
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15
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European Association of Urology Guidelines on Primary Urethral Carcinoma-2020 Update. Eur Urol Oncol 2020; 3:424-432. [PMID: 32605889 DOI: 10.1016/j.euo.2020.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/30/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023]
Abstract
CONTEXT Primary urethral carcinoma (PUC) is a rare cancer accounting for <1% of all genitourinary malignancies. OBJECTIVE To provide updated practical recommendations for the diagnosis and management of PUC. EVIDENCE ACQUISITION A systematic search interrogating Ovid (Medline), EMBASE, and the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was performed. EVIDENCE SYNTHESIS Urothelial carcinoma of the urethra is the predominant histological type of PUC (54-65%), followed by squamous cell carcinoma (16-22%) and adenocarcinoma (10-16%). Diagnosis of PUC depends on urethrocystoscopy with biopsy and urinary cytology. Pathological staging and grading are based on the tumour, node, metastasis (TNM) classification and the 2016 World Health Organization grading systems. Local tumour extent and regional lymph nodes are assessed by magnetic resonance imaging, and the presence of distant metastases is assessed by computed tomography of the thorax/abdomen and pelvis. For all patients with localised distal tumours (≤T2N0M0), partial urethrectomy or urethra-sparing surgery is a valid treatment option, provided that negative intraoperative surgical margins can be achieved. Prostatic Ta-Tis-T1 PUC can be treated with repeat transurethral resection of the prostate and bacillus Calmette-Guérin. In prostatic or proximal ≥ T2N0 disease, neoadjuvant cisplatin-based chemotherapy should be considered prior to radical surgery. All patients with locally advanced disease (≥T3N0-2M0) should be discussed within a multidisciplinary team. In men with locally advanced squamous cell carcinoma, curative radiotherapy combined with radiosensitising chemotherapy can be offered for definitive treatment and genital preservation. In patients with local urethral recurrence, salvage surgery or radiotherapy can be offered. For patients with distant metastatic disease, systemic therapy based on tumour characteristics can be evaluated. CONCLUSIONS These updated European Association of Urology guidelines provide up-to-date guidance for the contemporary diagnosis and management of patients with suspected PUC. PATIENT SUMMARY Primary urethral carcinoma (PUC) is a very rare, but aggressive disease. These updated European Association of Urology guidelines provide evidence-based guidance for clinicians treating patients with PUC.
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16
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Mano R, Vertosick EA, Sarcona J, Sjoberg DD, Benfante NE, Donahue TF, Herr HW, Donat SM, Bochner BH, Dalbagni G, Goh AC. Primary urethral cancer: treatment patterns and associated outcomes. BJU Int 2020; 126:359-366. [PMID: 32336001 DOI: 10.1111/bju.15095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate treatment patterns and associated outcomes of patients with urethral cancer. PATIENTS AND METHODS After obtaining institutional review board approval we identified 165 patients treated for primary urethral cancer between 1956 and 2017. Treatment included monotherapy (surgery or radiation), dual therapy (surgery+radiation, surgery+chemotherapy, or chemotherapy+radiation) or triple therapy (surgery+radiation+chemotherapy). Rates of different treatments were described by treatment year. The association between treatment type and outcomes was evaluated with multivariable Cox regression models, adjusting for disease characteristics. RESULTS The study cohort included 74 men and 91 women, with a median age of 61 years. Common histologies were squamous cell (36%), urothelial (27%) and adenocarcinoma (25%). At presentation, 72% of patients had invasive disease, 24% had nodal involvement, and 5% had metastases. Treatment included monotherapy (57%), dual therapy (21%), and triple therapy (10%). The use of monotherapy decreased over time, while rates of dual therapy remained consistent, and rates of triple therapy increased. The median follow-up was 4.7 years. Estimated 5-year local recurrence-free, disease-specific and overall survival were 51%, 48% and 41%, respectively. Monotherapy was associated with decreased local recurrence-free survival after adjusting for stage, histology, sex and year of treatment (P = 0.017). There was no evidence that treatment type was associated with distant recurrence, cancer-specific or overall survival. CONCLUSIONS We found preliminary evidence that multimodal therapy, more commonly used in recent years, was of benefit in patients with primary urethral cancer. This finding should be confirmed in further studies involving multiple centres because of the low incidence of the disease.
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Affiliation(s)
- Roy Mano
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA.,Department of Urology, Tel-Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Joseph Sarcona
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA.,Department of Urology, Lenox Hill Hospital, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Nicole E Benfante
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Timothy F Donahue
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Harry W Herr
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - S Machele Donat
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Bernard H Bochner
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Guido Dalbagni
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Alvin C Goh
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
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17
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Current Disease Management of Primary Urethral Carcinoma. Eur Urol Focus 2019; 5:722-734. [DOI: 10.1016/j.euf.2019.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/06/2019] [Accepted: 07/02/2019] [Indexed: 12/19/2022]
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18
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Davuluri M, Long B, Semple S, Villanueva-Siles E, Aboumohamed A. Primary Urethral Melanoma: A Case Report and Literature Review. Urology 2019; 126:1-4. [PMID: 30605694 DOI: 10.1016/j.urology.2018.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
Abstract
Patients with localized urethral melanoma have a high risk of recurrence and poor disease-specific survival. Multi-disciplinary approach including surgery, radiation therapy, and chemotherapy/immunotherapy is needed to maximize survival. Current research efforts include investigation of novel tyrosine kinases as well as the combination of targeted therapies with immunotherapies in this population. Combinations may provide a synergistic effect to overcome various obstacles to disease response.
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Affiliation(s)
- Meenakshi Davuluri
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Stacia Semple
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Ahmed Aboumohamed
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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19
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Urethral Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Gakis G. Urethral Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_40-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Abudurexiti M, Wang J, Shao N, Wan FN, Zhu Y, Dai B, Ye DW. Prognosis of rare pathological primary urethral carcinoma. Cancer Manag Res 2018; 10:6815-6822. [PMID: 30584373 PMCID: PMC6289122 DOI: 10.2147/cmar.s184197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Urethral carcinoma (UC), as a rare tumor, is not widely studied. There have been no systematic studies of rare pathological types of UC. We conducted this study to further investigate rare pathological types of primary urethral carcinoma (PUC). Materials and methods We used the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate prognostic factors in rare pathological types of PUC. From 1978 to 2015, 2,651 and 257 cases were identified in the SEER database as common and rare pathological types of PUC, respectively. Overall and cancer-specific survival (CSS) times were computed using the Kaplan–Meier method, and the Cox proportional hazards analysis was used to evaluate patient age at diagnosis, gender, race, and TNM stage. Results The median overall survival (OS) rates were 36 and 59 months for rare and common pathological groups, respectively, and their respective 10-year OS rates were 31.9% and 42.4%, respectively. The median CSS rate was 61 months for the rare pathological group. Through multivariate analysis, it was found that age, race, T stage, and M stage were independent prognostic risk factors for rare pathological type of urethral cancer. In the age group, the HR ratio of patients aged older than 60 years and younger or equal to 60 years was 2.778 (P<0.001). The HR ratio of other races to Whites was 1.444 (P=0.040). In TNM staging, the HR ratio between T3–T4 and Ta–T2 was 2.386 (P=0.046), and the HR value of M1 and M0 was 5.847 (P<0.001). Conclusion Age, race, T stage, and M stage were predictive of OS and CSS in rare pathological PUC.
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Affiliation(s)
- Mierxiati Abudurexiti
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Jun Wang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Ning Shao
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Fang-Ning Wan
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,
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22
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Survival Outcomes Associated With Female Primary Urethral Carcinoma: Review of a Single Institutional Experience. Clin Genitourin Cancer 2018; 16:e1003-e1013. [DOI: 10.1016/j.clgc.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/19/2018] [Accepted: 05/11/2018] [Indexed: 11/23/2022]
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23
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Gustafson LW, Christiansen AG, Majeed H, Humaidan P. Nonspecific Symptoms in a Rare Case of Urethral Adenocarcinoma in a 58-Year-Old Female. Case Rep Obstet Gynecol 2018; 2018:9010246. [PMID: 29951331 PMCID: PMC5989283 DOI: 10.1155/2018/9010246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
Abstract
Cancer of the urethra is very rare with an age-adjusted incidence of only 0.6 per million women in Europe. The etiology is multifactorial and the incidence increases with age, with the highest rates in patients 75 years or older. We herein describe a 58-year-old woman referred to our unit due to pollakisuria and repeated lower urinary tract infections. The gynecological examination revealed a suspect area in the anterior wall of vagina. Subsequently, ultrasound examination, MRI, and PET-CT scan followed by vaginal biopsies revealed a urethral adenocarcinoma.
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Affiliation(s)
- Line Winther Gustafson
- Department of Gynaecology and Obstetrics, Region Hospital Viborg and Skive, Heiberg Allé 4, 8800 Viborg, Denmark
| | - Anne Gamst Christiansen
- Department of Gynaecology and Obstetrics, Region Hospital Viborg and Skive, Heiberg Allé 4, 8800 Viborg, Denmark
| | - Huda Majeed
- Department of Gynaecology and Obstetrics, Region Hospital Viborg and Skive, Heiberg Allé 4, 8800 Viborg, Denmark
| | - Peter Humaidan
- The Fertility Clinic, Region Hospital Viborg and Faculty of Health, Aarhus University, Aarhus, Denmark
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24
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Female Urethra Adenocarcinoma. Clin Genitourin Cancer 2018; 16:e263-e267. [DOI: 10.1016/j.clgc.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022]
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25
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Aleksic I, Rais-Bahrami S, Daugherty M, Agarwal PK, Vourganti S, Bratslavsky G. Primary urethral carcinoma: A Surveillance, Epidemiology, and End Results data analysis identifying predictors of cancer-specific survival. Urol Ann 2018; 10:170-174. [PMID: 29719329 PMCID: PMC5907326 DOI: 10.4103/ua.ua_136_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives Primary urethral carcinoma (PUC) is rare, accounting for <1% of genitourinary malignancies. Current knowledge regarding is founded upon tertiary care centers reporting their experiences. We aim to identify factors predictive of outcomes using a nationwide registry database. Materials and Methods The Surveillance, Epidemiology, and End Results-18 registries database was queried for cases of PUC ranging between 2004 and 2010. To identify PUC cases, ICD-O site code C68.0 was used as a filter, hence identifying PUC with histologic subtypes including urothelial carcinoma (UC), squamous cell carcinoma (SCC), and adenocarcinoma (AC). Tumor characteristics were compared using log-rank analysis, and survival outcomes were compared using Cox proportional hazards models. Results A total of 419 PUC cases were identified, 250 (59.7%) male and 169 (40.3%) female patients. The most common histology in men was UC (134, 53.6%), followed by SCC (87, 34.8%) and AC (29, 11.6%). The most common histology in women was AC (79, 46.7%), followed by SCC (43, 25.4%) and UC (42, 24.9%). Log-rank analysis illustrated significant difference in cancer-specific survival (CSS) for T-stage, N-stage, M-stage, and stage of PUC with all histological variants combined (P < 0.001). Multivariate Cox proportional hazards model demonstrated that stage and age were significant for survival, with a risk ratio of 1.033 (95% confidence interval [CI], 1.020-1.046)/year of increased age (P < 0.001) and 3.71 (95% CI, 2.72-5.05) for patients with regional or distant spread. Conclusions Knowledge of patient and tumor characteristics that influences survival is paramount in dictating management. The present study illustrates that age and stage are factors significantly associated with CSS in PUC.
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Affiliation(s)
- Ilija Aleksic
- Division of Urology, Albany Medical Center, Albany, NY, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama At Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Michael Daugherty
- Department of Urology, Upstate Medical University, Syracuse, NY, USA
| | - Piyush K Agarwal
- Center For Cancer Research, National Cancer Institute, Bethesda, MD, USA
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26
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Clear Cell Adenocarcinoma of the Urethra in Women: Distinctive MRI Findings for Differentiation From Nonadenocarcinoma and Non-Clear Cell Adenocarcinoma of the Urethra. AJR Am J Roentgenol 2017; 208:805-811. [PMID: 28140610 DOI: 10.2214/ajr.16.16929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Abstract
Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.
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28
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Zargar-Shoshtari K, Sexton WJ, Poch MA. Management of Urethral Recurrences: Urothelial and Nonurothelial. Urol Clin North Am 2016; 43:515-521. [PMID: 27717437 DOI: 10.1016/j.ucl.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article discusses the diagnostic and therapeutic options in the management of urethral cancer recurrence in patients treated with urethral sparing cystectomy as well as those who had urethral preservation following primary urethral carcinoma.
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Affiliation(s)
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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29
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Female Urethral Diverticulum with Malignancy at Presentation. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0049-1] [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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30
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Multimodal management of primary adenocarcinoma of the female urethra: About four cases. Cancer Radiother 2016; 20:169-75. [DOI: 10.1016/j.canrad.2015.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/21/2022]
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31
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Harari SE, Cheng L, Osunkoya AO. Primary mucinous adenocarcinoma of the female urethra: a contemporary clinicopathologic analysis. Hum Pathol 2016; 47:132-7. [DOI: 10.1016/j.humpath.2015.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/04/2015] [Accepted: 09/10/2015] [Indexed: 12/24/2022]
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32
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Abstract
Primary urethral carcinoma is a rare malignancy with an annual age-adjusted incidence rate of 1.5 per million in females in the U.S. The three main histologic subtypes include transitional-cell carcinoma, squamous-cell carcinoma, and adenocarcinoma. Of these, adenocarcinoma is the least common. Female urethral carcinomas are aggressive neoplasms with a generally poor prognosis. We report a case of the clear-cell variant of adenocarcinoma.
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33
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Kang M, Jeong CW, Kwak C, Kim HH, Ku JH. Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients. J Korean Med Sci 2015; 30:1143-9. [PMID: 26240493 PMCID: PMC4520946 DOI: 10.3346/jkms.2015.30.8.1143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/15/2015] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (≥T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.
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Affiliation(s)
- Minyong Kang
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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34
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Tritschler S, Lellig K, Roosen A, Horng A, Stief C. [Organ and function preservation in urethral cancer]. Urologe A 2014; 53:1310-5. [PMID: 25113827 DOI: 10.1007/s00120-014-3555-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Primary urethral carcinomas are rare tumors that can occur both in men and women. Histological patterns of these tumors are mixed, urothelial tumors occur as well as squamous cell tumors or adenocarcinomas.There are different clinical factors that define clinical prognosis, and the 1- and 5-year cancer-free survival is 75% and 54%. Therapy of locally limited disease is surgical resection, and organ-preserving treatment is possible if negative frozen sections prove complete surgical resection. However, in men a perineal urethrostomy might be necessary, and in women there is a high risk of urinary incontinence if more than 2 cm of the distal urethra is resected.In case of locally advanced tumors or tumors of the proximal urethra, a radical urethrectomy with supravesical urinrary diversion is necessary. In some cases neoadjuvant (radio-)chemotherapy may be an option.
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Affiliation(s)
- S Tritschler
- Urologische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München, Marchioninistraße 15, 81377, München, Deutschland,
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35
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Yaegashi H, Mizokami A, Narimoto K, Kumano T, Namiki M. Primary female urethral adenocarcinoma treated with high dose rate brachytherapy, external beam radiotherapy, and chemotherapy. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Iborra F, Murez T, Millet I, Serre I, Poinas G, Thuret R. Les cancers primitifs de l’urètre. ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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37
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D''Arrigo L, Costa A, Fraggetta F, Pennisi M, Pepe P, Aragona F. Carcinosarcoma of the Female Urethra. Urol Int 2014; 96:370-2. [PMID: 24481023 DOI: 10.1159/000355089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
Abstract
Carcinosarcoma is a rare malignant tumor with a biphasic morphology characterized by the presence of a malignant epithelial and mesenchymal component. It has been reported in many organs, including the genitourinary tract. We describe a case of a 47-year-old woman admitted to our hospital for history of recurrent urinary tract infection, dysuria and discharge of bloody fluid from the urethra at the end of urination. A tender palpable mass under the anterior vaginal wall was found and pathological examination showed a urethral carcinosarcoma. The histopathogenetic hypothesis and clinical management were considered in this report.
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Affiliation(s)
- L D''Arrigo
- Urology Unit and Pathology Unit, Cannizzaro Hospital, Catania, Italy
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38
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Anterior urethrectomy for primary carcinoma of the female urethra mimicking a urethral caruncle. Int Neurourol J 2014; 17:197-9. [PMID: 24466468 PMCID: PMC3895513 DOI: 10.5213/inj.2013.17.4.197] [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] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/19/2013] [Indexed: 11/28/2022] Open
Abstract
Here we report a case of primary carcinoma of the female urethra. A 52-year-old woman presented with a palpable urethral mass associated with intermittent pain that she first experienced a few months prior. Clinical examination showed a urethral mass that appeared to be a caruncle; therefore, simple carunclectomy was performed. However, on histological examination, the mass was revealed to be a squamous cell carcinoma; therefore, anterior urethrectomy was performed. During a 4-year follow-up period, the patient has been well with no dysuria, dyspareunia, or incontinence.
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Primary clear cell adenocarcinoma of a urethral diverticulum treated with multidisciplinary robotic anterior pelvic exenteration. Case Rep Med 2013; 2013:387591. [PMID: 24454400 PMCID: PMC3884856 DOI: 10.1155/2013/387591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/03/2013] [Indexed: 11/18/2022] Open
Abstract
Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006). Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration.
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40
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Siosaki MD, Machado RD, Souza ATF, Magnabosco WJ, Santos AC, Gonçalves FZ, Pereira FC, de Araújo Silva CF, Faria EF. Primary proximal urethral adenocarcinoma: Case report and brief review. Can Urol Assoc J 2013; 7:E499-501. [PMID: 23914268 DOI: 10.5489/cuaj.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary urethral cancer in females is rare. It has a poor prognosis. The published data on this topic are limited, composed mostly of small case series. This paper presents a case of an advanced adenocarcinoma of the urethra, intestinal type, treated with anterior exenteration.
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41
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Suzuki T, Furuse H, Kurita Y, Imanishi T, Tamura K, Otsuka A, Mugiya S, Ozono S. [Long-term survival of metastatic clear cell adenocarcinoma of the female urethra by multidisciplinary treatment: a case report]. Nihon Hinyokika Gakkai Zasshi 2013; 104:549-553. [PMID: 23819370 DOI: 10.5980/jpnjurol.104.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We report a case of clear cell adenocarcinoma of the female urethra. A 57-year-old woman presented with complaint of gross hematuria. Abdominal ultrasonography, cystourethroscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the urethral tumor was invasive to bladder neck. Clinical stage was determined as cT3N1M0, then anterior pelvic exenteration and ileal conduit formation were performed. The pathological diagnosis was clear cell adenocarcinoma of urethra and the stage was pT3N1. The patient received TS-1 and cisplatin for postoperative recurrence, but she died from multiple lung metastasis 54 months after the operation. Clear cell adenocarcinoma of the female urethra is rare case in the Japanese literatures. Pathogenesis and management of this rare condition are discussed.
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Affiliation(s)
- Takahisa Suzuki
- Department of Urology, Hamamatsu University School of Medicine
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42
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Gakis G, Witjes JA, Compérat E, Cowan NC, De Santis M, Lebret T, Ribal MJ, Sherif AM. EAU guidelines on primary urethral carcinoma. Eur Urol 2013; 64:823-30. [PMID: 23582479 DOI: 10.1016/j.eururo.2013.03.044] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/23/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). OBJECTIVE To review the current literature on the diagnosis and treatment of patients with primary UC and assess its level of scientific evidence. EVIDENCE ACQUISITION A systematic literature search was performed to identify studies reporting urethral malignancies. Medline was searched using the controlled vocabulary of the Medical Subject Headings database, along with a free-text protocol. EVIDENCE SYNTHESIS Primary UC is considered a rare cancer, accounting for <1% of all malignancies. Risk factors for survival include age, tumour stage and grade, nodal stage, presence of distant metastasis, histologic type, tumour size, tumour location, and modality of treatment. Pelvic magnetic resonance imaging is the preferred method to assess the local extent of urethral tumour; computed tomography of the thorax and abdomen should be used to assess distant metastasis. In localised anterior UC, urethra-sparing surgery is an alternative to primary urethrectomy in both sexes, provided negative surgical margins can be achieved. Patients with locally advanced UC should be discussed by a multidisciplinary team of urologists, radiation oncologists, and oncologists. Patients with noninvasive UC or carcinoma in situ of the prostatic urethra and prostatic ducts can be treated with a urethra-sparing approach with transurethral resection and bacillus Calmette-Guérin (BCG). Cystoprostatectomy with extended pelvic lymphadenectomy should be reserved for patients not responding to BCG or as a primary treatment option in patients with extensive ductal or stromal involvement. CONCLUSIONS The 2013 guidelines document on primary UC is the first publication on this topic by the EAU. It aims to increase awareness in the urologic community and provide scientific transparency to improve outcomes of this rare urogenital malignancy.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tübingen, Germany.
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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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Prognostic Factors and Outcomes After Definitive Treatment of Female Urethral Cancer: A Population-based Analysis. Urology 2012; 80:374-81. [DOI: 10.1016/j.urology.2012.02.058] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 11/19/2022]
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46
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Derksen JW, Visser O, de la Rivière GB, Meuleman EJ, Heldeweg EA, Lagerveld BW. Primary urethral carcinoma in females: an epidemiologic study on demographical factors, histological types, tumour stage and survival. World J Urol 2012; 31:147-53. [DOI: 10.1007/s00345-012-0882-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/02/2012] [Indexed: 11/25/2022] Open
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47
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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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48
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Hampl M, Langkamp B, Lux J, Kueppers V, Janni W, Müller-Mattheis V. The risk of urinary incontinence after partial urethral resection in patients with anterior vulvar cancer. Eur J Obstet Gynecol Reprod Biol 2011; 154:108-12. [DOI: 10.1016/j.ejogrb.2010.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 07/25/2010] [Accepted: 08/26/2010] [Indexed: 10/19/2022]
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49
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Cruz-Ruiz M, Pozo-García A, Gené-Heym A, Reynes-Sancho C, Oleza-Simo J. Adenocarcinoma de células claras uretral intradiverticular. Presentación de un nuevo caso en una mujer. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Libby B, Chao D, Schneider BF. Non-surgical treatment of primary female urethral cancer. Rare Tumors 2010; 2:e55. [PMID: 21139970 PMCID: PMC2994528 DOI: 10.4081/rt.2010.e55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/19/2010] [Indexed: 11/25/2022] Open
Abstract
Primary carcinomas of the female urethra are extremely rare, with an annual incidence of less than ten in one million. Currently, there is no consensus regarding management of this malignancy. However, there have been several case reports demonstrating the efficacy of chemoradiation in the treatment of female urethral cancer. In this report we present two cases of female primary urethral adenocarcinoma that were treated by concomitant chemotherapy and external beam radiotherapy, followed by interstitial brachytherapy.
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