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Zhang JQ, Duan Y, Wang K, Zhang XL, Jiang KH. Metachronous urothelial carcinoma in the renal pelvis, bladder, and urethra: A case report. World J Clin Cases 2023; 11:3062-3069. [PMID: 37215428 PMCID: PMC10198092 DOI: 10.12998/wjcc.v11.i13.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra. Most UCs are in the bladder and have multifocal growth. Upper urinary tract UC (UTUC), which occurs in the renal pelvis or ureter, accounts for only 5% to 10% of UCs.
CASE SUMMARY In March 2015, a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis. The doctors administered radical nephroureterectomy and bladder cuff excision. Although the doctors recommended intravesical chemotherapy and regular follow-up, he rejected this advice. In December 2016, the patient presented at our hospital with dysuria. We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy. In November 2021, he presented again with urethral bleeding. We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy. Since then, he has visited regularly for 6-mo follow-ups, and was in stable condition as of December 2022.
CONCLUSION UTUC is prone to seeding and recurrence. Adjuvant instillation therapy and intense surveillance are crucial for these patients.
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Affiliation(s)
- Jian-Qing Zhang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Yu Duan
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Kun Wang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
| | - Xiao-Li Zhang
- Department of Biomedicine, Guizhou University, Guiyang 550025, Guizhou Province, China
| | - Ke-Hua Jiang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
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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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3
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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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Chen F, Joshi S, Carthon BC, Osunkoya AO. A Contemporary Clinicopathologic Analysis of Primary Urothelial Carcinoma of the Urethra Without Concurrent Renal Pelvic, Ureteral, or Bladder Carcinoma. Int J Surg Pathol 2021; 30:15-22. [PMID: 34255581 DOI: 10.1177/10668969211032481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Primary urothelial carcinoma (UCa) of the urethra is relatively uncommon, and the underlying pathogenesis has not been well characterized, especially in the absence of concurrent UCa at other sites. A search for cases of primary UCa of the urethra was conducted. Patients with concurrent UCa of the renal pelvis, ureter, or bladder at the time of diagnosis of the primary tumor were excluded. Clinicopathologic and follow-up data were obtained. A total of 35 cases from 30 patients (27 male and 3 female) were included in the study. The mean patient age at the initial diagnosis was 71 years (range: 41-90 years). Cases were composed of high-grade UCa (26 of 35 = 74%), low-grade UCa (4 of 35 = 11%), and UCa in situ (5 of 35 = 14%). Invasion was present in 14 of 26 (54%) cases of high-grade UCa. Interestingly, 23 of 30 (77%) patients had a previous history of UCa including 7 (30%) cases with divergent differentiation or variant histology. Follow-up data were available in 23 patients with a mean duration of 26.7 months (range: 0.6-87 months). Eleven patients (31%) died of metastatic UCa. This is one of the largest studies to date of primary UCa of the urethra without concurrent UCa of the renal pelvis, ureter, or bladder. Previous history of UCa of the bladder, especially with divergent differentiation or variant histology is conceivably a key risk factor for developing subsequent primary UCa of the urethra. These findings are important for the development of surveillance protocols and therapeutic strategies.
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Affiliation(s)
- Fengming Chen
- 12239Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Shreyas Joshi
- 1371Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA.,Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA
| | - Bradley C Carthon
- Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Adeboye O Osunkoya
- 12239Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA.,1371Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA.,Winship Cancer Institute of Emory University, Atlanta, GA 30322, USA.,Department of Pathology, Veterans Affairs Medical Center, Decatur, GA 30033, USA
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Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
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Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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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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Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Kübler H, Stenzl A, Gakis G. Urethral recurrence after radical cystectomy for urothelial carcinoma: A systematic review and meta-analysis. Urol Oncol 2018; 36:54-59. [DOI: 10.1016/j.urolonc.2017.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/05/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022]
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Chan Y, Fisher P, Tilki D, Evans CP. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management. BJU Int 2015; 117:563-9. [DOI: 10.1111/bju.13370] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yvonne Chan
- Department of Urology; Medical Center; University of California, Davis; Sacramento CA USA
| | - Patrick Fisher
- Department of Urology; Medical Center; University of California, Davis; Sacramento CA USA
| | - Derya Tilki
- Department of Urology; Medical Center; University of California, Davis; Sacramento CA USA
| | - Christopher P. Evans
- Department of Urology; Medical Center; University of California, Davis; Sacramento CA USA
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9
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Transurethral prostate biopsy before radical cystectomy remains clinically relevant for decision-making on urethrectomy in patients with bladder cancer. Int J Clin Oncol 2011; 18:75-80. [DOI: 10.1007/s10147-011-0346-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
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Tsukamoto T, Kitamura H, Takahashi A, Masumori N. Treatment of invasive bladder cancer: lessons from the past and perspective for the future. Jpn J Clin Oncol 2004; 34:295-306. [PMID: 15333680 DOI: 10.1093/jjco/hyh048] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Radical cystectomy with lymphadenectomy is the gold standard for treatment of invasive bladder cancer. However, the treatment alone does not always provide a satisfactory result for the disease extending outside the bladder. In this review we discuss several clinical issues in the diagnosis and treatment of this invasive disease. Although the quality of diagnostic imaging modalities has improved, they are still not sensitive enough for the staging of the disease, especially for early invasive disease. In addition, lack of serum markers hinders appropriate monitoring of patients with the disease. Regarding the surgical aspect of lymphadenectomy, the area of its dissection, the standard number of nodes retrieved and the method of pathological examination should be established so that the clinical benefits of surgery can be more clearly defined. Neoadjuvant chemotherapy for invasive disease is promising for improvement of survival of patients. A chemotherapy regimen as effective as, but less toxic than, MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) has been reported and several phase III clinical trials have been launched to determine the benefits of adjuvant or neoadjuvant chemotherapy with newly developed agents. However, we still lack a chemotherapy regimen more effective than MVAC, which is the most crucial issue in the treatment of this invasive disease. An alternative option for such disease may be bladder preservation with transurethral resection of tumor followed by chemoradiotherapy. However, patients who are indicated for this treatment may be limited to those with early invasive disease having certain favorable clinical and pathological features.
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Affiliation(s)
- Taiji Tsukamoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
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