High-dose-rate brachytherapy - a novel treatment approach for primary clear cell adenocarcinoma of male urethra

Primary clear cell adenocarcinoma of prostate: A diagnostic challenge

Clear cell adenocarcinoma (CCA) rarely occurs in men, not to mention in prostate. We reported a 44-year-old male patient who suffered from recurrent dysuria and frequency for 6 months. Transurethral resection of the prostate was performed to relieve bladder outlet obstruction. However, CCA of the prostate was confirmed through pathological examination. A thorough checkup was performed to distinguish it from metastatic clear cell carcinoma from other primary origins. Currently, no consensus for the treatment of CCA of the prostate has been reached. After discussing with the patient, he decided to receive immunotherapy with pembrolizumab. Herein, we reported this rare case of CCA in the prostate.

Molecular profiling of clear cell adenocarcinoma of the urinary tract

Clear cell adenocarcinoma (CCA) of the urinary tract is a rare type of malignancy whose molecular profiles remain undefined. Here we reported an integrated clinicopathologic and molecular profiling analysis of four cases of clear cell adenocarcinoma arising in the urethra or the bladder. Utilizing a clinically validated 130-gene exon-sequencing assay, we identified recurrent pathogenic PIK3CA (p. E545K) and KRAS (p.G12D) variants in three of four (75%) of the cases. In addition, an APC variant (P.S2310X), a TP53 variant (p.R273C), and a MYC amplification event were identified. The only CCA case without either PIK3CA or KRAS variants has a distinct pathogenesis through BK virus, demonstrated by positive BK virus PCR and SV40 immunohistochemistry. The novel finding of recurrent variants in the PI3K/AKT/mTOR pathway provides not only insights into oncogenesis but also potential clinical therapeutic targets for patients with clear cell adenocarcinoma of the urinary tract.

Clear cell adenocarcinoma of the prostatic urethra: A case report

Introduction

Clear cell adenocarcinoma of the prostatic urethra in men is an extremely rare disease, with only eight case reports published.

Case presentation

A 56‐year‐old man visited our hospital for gross hematuria. Urinary cytology detected class V, cystoscopy showed no abnormal findings, and contrast‐enhanced computed tomography also showed no abnormal findings in his upper urinary tract except for a low‐enhancement lesion on his left prostate lobe. Magnetic resonance imaging revealed a cystic lesion surrounding the prostate that was suspected of being urethral or prostate cancer, so transurethral resection was performed. A papillary tumor was detected at the prostatic urethra, and after resecting this tumor, a cavity showing multiple tumors was observed. The final pathological diagnosis was clear cell adenocarcinoma. Laparoscopic radical cystectomy and urethrectomy were thus performed. The pathological diagnosis was the same as at the primary tumor site.

Conclusion

We herein report a case of clear cell adenocarcinoma of the prostatic urethra.