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Strouthos I, Tselis N, Ferentinos K, Karagiannis E, Milickovic N, Chatzikonstantinou G, Feder O, Zamboglou N. Intraluminal High-Dose-Rate Brachytherapy—An Alternative Organ-Preserving Approach for Primary Male Urothelial Carcinoma With Panurethral Involvement. Pract Radiat Oncol 2020; 10:e53-e56. [DOI: 10.1016/j.prro.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
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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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High-dose-rate brachytherapy - a novel treatment approach for primary clear cell adenocarcinoma of male urethra. J Contemp Brachytherapy 2015. [PMID: 26207115 PMCID: PMC4499518 DOI: 10.5114/jcb.2015.52316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of male urethral cancer is rare with age preponderance of 50 to 60 years. The standard management approach is surgery. Here, we present a novel treatment approach for male urethral cancer. Thirty-six year old male, case of primary clear cell adenocarcinoma of urethra who refused surgery, underwent cystoscopic assisted intraluminal HDR brachytherapy. Patient received a dose of 36 Gy in 9 fractions (4 Gy per fraction) followed by a boost of 24 Gy in 6 fractions. At 11 months post treatment, disease is well controlled with no post treatment toxicity so far. Intraluminal brachytherapy seems to be an effective novel treatment for male urethral cancer.
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Amir RA, Sheikh SS. Angioleiomyoma of urethra: A case report. Int J Surg Case Rep 2015; 10:195-7. [PMID: 25863994 PMCID: PMC4430131 DOI: 10.1016/j.ijscr.2015.03.055] [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] [Received: 01/24/2015] [Revised: 03/18/2015] [Accepted: 03/29/2015] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Angioleiomyomas are benign smooth muscle tumors that arise from blood vessel walls and commonly involve the deep dermal and subcutaneous tissue. Urethral angioleiomyomas are only rarely seen with only less than 5 cases reported in literature. PRESENTATION OF CASE We herein present a case of a 72 year old man who presented with gross hematuria. Cystoscopy showed a polypoid urethral lesion that was resected and on pathologic examination was diagnosed as angioleiomyoma. DISCUSSION Differential diagnoses of a urethral polypoid lesion, including inflammatory and neoplastic conditions are discussed. The main emphasis is on recognition and review of angioleiomyoma features when presenting in commonly encountered locations and other sites that are only rarely involved. CONCLUSION This rare case reports an elderly patient with angioleiomyoma in an extremely unusually encountered location and presenting with unusual symptoms of gross hematuria that did not recur after resection of the lesion.
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Affiliation(s)
- R A Amir
- University of Dammam, P.O. Box: 12113, Dhahran 31311, Saudi Arabia.
| | - S S Sheikh
- Chief of Pathology Services Division, Johns Hopkins Aramco Health Care, Dhahran, Saudi Arabia.
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Dayyani F, Hoffman K, Eifel P, Guo C, Vikram R, Pagliaro LC, Pettaway C. Management of advanced primary urethral carcinomas. BJU Int 2014; 114:25-31. [PMID: 24447439 DOI: 10.1111/bju.12630] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary urethral carcinoma (PUC) is a rare malignancy accounting for <1% of genitourinary cancers, with a predilection for men and African-Americans. The sites and histology of urethral carcinoma vary by gender and anatomical location. Squamous cell carcinoma is most common among both genders but adenocarcinomas are noted in 15-35% of cases among women. Obstructive or irritative symptoms and haematuria are common modes of presentation. Clinical evaluation includes cystourethroscopy with biopsy and examination under anaesthesia. Magnetic resonance imaging provides a highly effective method to image the primary tumour while defıning the potential involvement of surrounding structures. Most tumours are localised, with regional metastases to nodal sites seen in up to 30% of cases in both genders, while distant metastases at presentation are rare (0-6%), but occur in up to 40% of cases with recurrent disease. Among men, the two most important prognostic factors are disease location and stage. Low-stage tumours (T1-2) and tumours involving the fossa navicularis or the penile urethra have a better prognosis than higher stage tumours (>T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus-related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi-institutional studies are needed to better define the optimal treatment approach for this disease entity.
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Affiliation(s)
- Farshid Dayyani
- Division of Hematology and Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA; Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Moon KS, Jung S, Lee KH, Hwang EC, Kim IY. Intracranial metastasis from primary transitional cell carcinoma of female urethra: case report & review of the literature. BMC Cancer 2011; 11:23. [PMID: 21244713 PMCID: PMC3033851 DOI: 10.1186/1471-2407-11-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 01/19/2011] [Indexed: 11/16/2022] Open
Abstract
Background Transitional cell carcinoma (TCC) of the female urethra is a rare urological malignancy, and intracranial metastasis of this cancer has not yet been reported in the literature. This review is intended to present a case of multiple intracranial metastasis in a female patient with a remote history of primary urethral TCC. Case Presentation A 49-year-old woman, presented with a prolapsed mass in urethral orifice that was diagnosed as primary urethral TCC with distant lung and multiple bone metastases. The patient subsequently underwent chemotherapy under various regimens. A year later, the patient developed headache and vomiting which as was found to be due to multiple intracranial metastasis. The patient underwent surgical resection of the largest lesion located on the cerebellum, and consecutively gamma knife radiosurgery was performed for other small-sized lesions. Pathological examination of the resected mass revealed a metastatic carcinoma from a known urethral TCC. Serial work-up of systemic metastasis revealed concomitant aggravation of lung, spleen, and liver metastasis. The patient died of lung complication 2 months after the diagnosis of brain metastasis. Conclusion To the best of our knowledge, this is the first reported case of cerebral metastasis from primary urethral TCC, with pathological confirmation. As shown in intracranial metastasis of other urinary tract carcinoma, this case occurred in the setting of uncontrolled systemic disease and led to dismal prognosis in spite of aggressive interventional modalities.
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Affiliation(s)
- Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea
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Abstract
Primary carcinoma of the male urethra accounts for less than 1% of malignancies in males. Mucinous adenocarcinoma of the urethra is extremely rare, and its biologic behavior is not well known. We report a case of mucinous adenocarcinoma showing the histologic features of colloid adenocarcinoma that appears to have evolved either by neoplastic degeneration of goblet cells found in the urethral epithelium or by malignant degeneration of persistent glandular elements of uretheritis cystica and glandularis.
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Affiliation(s)
- Rosenblat Yvgenia
- Department of Pathology, Sackler Faculty of Medicine, Sackler School of Medicine, Hasharon Hospital, Petah Tikva, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
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Curtis MW, Evans AJ, Srigley JR. Mucin-producing urothelial-type adenocarcinoma of prostate: report of two cases of a rare and diagnostically challenging entity. Mod Pathol 2005; 18:585-90. [PMID: 15778694 DOI: 10.1038/modpathol.3800317] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The differential diagnosis of mucin-producing adenocarcinoma of the prostate includes conventional prostatic adenocarcinoma with mucin production, secondary adenocarcinoma usually of colorectal origin and, very rarely, urothelial-type adenocarcinoma arising from either the prostatic urethra or proximal ducts. Conventional prostatic adenocarcinoma with mucin production is readily identified by routine microscopy and immunohistochemistry. The distinction between secondary adenocarcinoma and urothelial-type adenocarcinoma, however, can present a significant diagnostic challenge. In addition, documented examples of the latter in the prostate are exceptionally rare. A transurethral resection of prostate specimen and prostatic needle biopsies from two patients showing urothelial-type adenocarcinoma of the prostate were identified in our consultation files. One of the patients subsequently underwent a radical prostatectomy. Both patients had negative gastrointestinal endoscopic workups. Transurethral resection of prostate material from two patients with clinically confirmed secondary adenocarcinoma of colonic origin involving the prostate and a prostatectomy specimen with mucinous conventional prostatic adenocarcinoma were also identified for comparison purposes. Formalin-fixed, paraffin-embedded sections were stained for prostate-specific antigen (PSA), prostatic acid phosphatase, carcinoembryonic antigen, cytokeratin 7, cytokeratin 20 and high molecular weight cytokeratin 34betaE12. The urothelial-type adenocarcinoma cases were diffusely positive for cytokeratin 7 and focally positive for 34betaE12 and cytokeratin 20, consistent with an origin from the urothelium of the prostatic urethra or proximal prostatic ducts. In contrast, the secondary adenocarcinoma of colonic origin cases were diffusely cytokeratin 20 positive and either negative or focally positive for cytokeratin 7 and negative for 34betaE12. The mucinous conventional prostatic adenocarcinoma was positive for PSA and prostatic acid phosphatase and negative for cytokeratin 7, cytokeratin 20 and 34betaE12. All tumors were positive for carcinoembryonic antigen.
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Affiliation(s)
- Michael W Curtis
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Ahmad NA, Memon A, Hussainy A. Abdominoperineal excision of male lower urinary tract for synchronous adenocarcinoma of urethra and urinary bladder. Urology 2005; 65:591. [PMID: 15780385 DOI: 10.1016/j.urology.2004.09.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Accepted: 09/14/2004] [Indexed: 10/25/2022]
Abstract
Urethral adenocarcinoma is the least common histologic subtype of a rare primary carcinoma of the male urethra. Its site of origin remains speculative. The scarcity of reported cases in the literature makes it difficult to define the optimal management. This report is of a 40-year-old morbidly obese man with synchronous adenocarcinoma of the bulbar urethra and bladder, treated surgically by en bloc abdominoperineal penoprostatocystectomy. The pleural recurrence, after a disease-free period of 2 years, responded well to platinum-docetaxel-based systemic chemotherapy. Synchronous occurrence of adenocarcinoma of the urethra and bladder has not been previously reported. This case also highlights the possible role of upcoming adjuvant chemotherapeutic agents.
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Affiliation(s)
- Nazim Ali Ahmad
- Department of Surgery, The Aga Khan University, Karachi, Pakistan
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Dimarco DS, Dimarco CS, Zincke H, Webb MJ, Bass SE, Slezak JM, Lightner DJ. Surgical treatment for local control of female urethral carcinoma. Urol Oncol 2005; 22:404-9. [PMID: 15464921 DOI: 10.1016/s1078-1439(03)00174-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Revised: 09/12/2003] [Accepted: 10/22/2003] [Indexed: 11/23/2022]
Abstract
We reviewed 53 patients (mean age 63 years) who underwent partial urethrectomy (n = 26) or radical extirpation (n = 27) for primary female urethral cancer from 1948 through 1999. Clinical stage, histology, high pathologic stage (3 or 4) and grade, tumor location, nodal status, surgery type, adjuvant therapy, and treatment decade were candidate outcome predictors. The predominant carcinomas were squamous cell (n = 21), transitional cell (TCC) (n = 15), and adenocarcinoma (n = 14). For adjuvant therapy, 20 patients had radiation (8 preoperatively), 2 had radiation + chemotherapy, and 1 had chemotherapy alone. During mean follow-up of 12.8 years, 27 patients had recurrence; 15 local only, 2 distant only and 10 local + distant. Of patients undergoing partial urethrectomy for pT1-3 tumors, 6/27 (22%) had urethral recurrence. Overall, there were no bladder recurrences. Recurrence-free survival +/- standard error (SE) at 10 years was 45 + 8%. Those who recurred had a cancer mortality rate of 71% at 5 years postrecurrence. The estimated 10-year cancer-specific survival (CSS) and crude survival (CS) rates were 60 +/- 8% and 42 +/- 7%, respectively. Pathologic stage was predictive for local recurrence (P = 0.02) and CSS (P = 0.01). Positive nodes on pathology were related to local and distant recurrence and CSS (P = 0.01). Upon review, partial urethrectomy resulted in a high urethral recurrence rate (22%) with no bladder recurrences. These patients may be better served with radical urethrectomy and creation of continent catheterizable stoma.
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SOLSONA E, IBORRA I, RICÓS J, MONRÓS J, RUBIO J, ALMENAR S. Clinical Panurothelial Disease in Patients with Superficial Bladder Tumors: Therapeutic Implications. J Urol 2002. [DOI: 10.1016/s0022-5347(05)65073-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E. SOLSONA
- From the Departments of Urology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - I. IBORRA
- From the Departments of Urology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - J.V. RICÓS
- From the Departments of Urology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - J.L. MONRÓS
- From the Departments of Urology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - J. RUBIO
- From the Departments of Urology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain
| | - S. ALMENAR
- From the Departments of Urology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain
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Clinical Panurothelial Disease in Patients with Superficial Bladder Tumors:. J Urol 2002. [DOI: 10.1097/00005392-200205000-00016] [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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BHATI ANANT, GARDNER SANDY, HUSSEINZADEH NADER, BHATI AMAR. Urethral Leiomyoma: A Case Report and Discussion. J Gynecol Surg 1999. [DOI: 10.1089/gyn.1999.15.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Carcinoma of the female urethra is uncommon. The review of literature and our own experience indicates that early distal urethral cancers (squamous and adenocarcinoma) can be treated either with surgery (70-80% 5-year survival) or with radiotherapy (brachytherapy) with excellent results (75% 5-year survival). Early proximal or entire urethral cancers (squamous and adenocarcinoma), if treated surgically, will require exenterative procedures. Alternatively, these cancers can be treated with a combination of external beam and brachytherapy with or without chemotherapy with good results and preservation of organs. Surgery can be used for failures or persistent tumors. Advanced cancers require a multimodality approach, and a combination of radiation and chemotherapy appears to be the optimal way to treat these patients-with surgery to be used for biopsy-proven persistent tumors or recurrences.
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Affiliation(s)
- B Micaily
- Department of Radiation Oncology, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania 19102-1192, USA
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Kuettel MR, Parda DS, Harter WK, Rodgers JE, Lynch JH. Treatment of Female Urethral Carcinoma in Medically Inoperable Patients Using External Beam Irradiation and High Dose Rate Intracavitary Brachytherapy. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64830-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael R. Kuettel
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - David S. Parda
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - William K. Harter
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - James E. Rodgers
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
| | - John H. Lynch
- From the Departments of Radiation Medicine and Surgery, Division of Urology, Georgetown University School of Medicine, Washington, D. C
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Treatment of Female Urethral Carcinoma in Medically Inoperable Patients Using External Beam Irradiation and High Dose Rate Intracavitary Brachytherapy. J Urol 1997. [DOI: 10.1097/00005392-199705000-00041] [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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Abstract
An elderly man presented with urinary outflow obstruction and a smooth mass arising from the bulbar urethra. Biopsy revealed large cell lymphoma, B cell subtype. A literature review revealed no previous cases of undisseminated lymphoma arising within the male urethra. The obstructing mass and symptoms resolved with multiagent chemotherapy.
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Affiliation(s)
- P A Hatcher
- Division of Urology, University of Tennessee Medical Center at Knoxville 37920, USA
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20
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Affiliation(s)
- R R Dmochowski
- Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California
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Wong H, Krahn HP. Concomitant carcinoma of the penis and urethra treated with a unique method of continent diversion. J Urol 1992; 148:874-5. [PMID: 1512843 DOI: 10.1016/s0022-5347(17)36750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- H Wong
- Department of Urology, University of Manitoba, Winnipeg, Canada
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Grigsby PW, Corn BW. Localized urethral tumors in women: indications for conservative versus exenterative therapies. J Urol 1992; 147:1516-20. [PMID: 1593679 DOI: 10.1016/s0022-5347(17)37614-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The objectives of this retrospective review were to evaluate patient and tumor characteristics, survival, patterns of failure and sequelae of therapy for women with urethral carcinoma. Primary urethral carcinoma was diagnosed in 33 women referred to the Washington University Medical Center and the Mallinckrodt Institute of Radiology, Radiation Oncology Center from November 1959 through June 1988. Treatment consisted of surgery alone in 6 patients, surgery and irradiation in 7, and irradiation alone in 20. Median followup was 4.7 years. The 5-year overall and progression-free survivals for all patients were 41% and 36%, respectively. Tumor location, size and T stage were predictive for survival. No patient with a lesion of greater than 4 cm. survived at 5 years if treated with irradiation alone, surgery alone or irradiation and nonexenterative surgery. Exenterative surgery plus irradiation was curative in 1 of 4 patients. Pelvic failures occurred in approximately 50% of all patients. Severe complications of therapy occurred in 30% of the patients treated with irradiation alone, 1 of 7 treated with surgery and irradiation, and 0 of 6 treated with surgery only. Surgery only or irradiation only may be curative in patients with lesions less than 2 cm. Larger lesions require a combination of surgery and irradiation.
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Affiliation(s)
- P W Grigsby
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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24
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THE ROLE OF RADIATION THERAPY IN THE MANAGEMENT OF CARCINOMA OF THE MALE AND FEMALE URETHRA. Urol Clin North Am 1992. [DOI: 10.1016/s0094-0143(21)00401-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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WINFIELD HOWARDN, DONOVAN JAMESF, SEE WILLIAMA, LOENING STEFANA, WILLIAMS RICHARDD. Laparoscopic Pelvic Lymph Node Dissection for Genitourinary Malignancies: Indications, Techniques, and Results. J Endourol 1992. [DOI: 10.1089/end.1992.6.103] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
A case of a rare primary urethral carcinoma is presented. The histochemical characteristics of this tumor are identical to those of colon tumors. The patient was treated with segmental urethrectomy.
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Affiliation(s)
- D Yachia
- Departments of Urology, Silberberg Outpatient Clinic, Ramat Gan, Israel
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27
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Fernando JJ, Wanas TM. Primary transitional cell carcinoma of the anterior urethra: a rare presentation. Genitourin Med 1991; 67:244-6. [PMID: 2071129 PMCID: PMC1194681 DOI: 10.1136/sti.67.3.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 72 year old Caucasian male presented with symptoms and signs of littritis. There was no response to a two week course of doxycycline. Cysto-urethroscopy revealed a transitional cell carcinoma of the anterior urethra. As there was no response to deep x-ray therapy, radical amputation of the penis was carried out. The literature pertaining to this rare entity is reviewed.
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Affiliation(s)
- J J Fernando
- Department of Genitourinary Medicine, Royal Hospital, Wolverhampton, UK
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28
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Linn R, Moskovitz B, Munichor M, Levin DR. Transitional cell carcinoma of distal female urethra. Int Urol Nephrol 1990; 22:275-7. [PMID: 2210984 DOI: 10.1007/bf02550406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A rare case of carcinoma of female urethra from transitional cell origin is reported. The occurrence of primary transitional cell carcinoma in the urethra is being discussed, with review of the literature.
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Affiliation(s)
- R Linn
- Department of Urology and Pathology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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29
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Nikula KJ, Benjamin SA, Angleton GM, Lee AC. Transitional cell carcinomas of the urinary tract in a colony of beagle dogs. Vet Pathol 1989; 26:455-61. [PMID: 2603326 DOI: 10.1177/030098588902600601] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gross and light microscopic features of transitional cell carcinomas (TCC) of the urinary tract were examined in Beagle dogs used for the study of the long-term effects of low-dose, whole-body, 60Co gamma radiation. Thirty-eight cases of TCC occurred among 990 dogs that were from 0 to 14 years of age. There was no conclusive evidence of a radiation effect. The 38 TCC were equally divided between male and female dogs, but there was a significant difference in the sex distribution of urethra-origin TCC. Eleven males had a primary urethral TCC compared to only two females. There was no significant difference between the urethra-origin and bladder-origin TCCs in the number of tumors that caused clinical signs, metastasized, or that contributed to the death of the dog. All cases of urethral TCC in male dogs occurred in the prostatic urethra. The majority of these cases were not recognized to be neoplasms at gross necropsy, but microscopic examination revealed the TCC. Our findings differ from previous reports stating that TCC occurs more frequently in female than male dogs, and they especially differ from reports claiming that urethra-origin TCC is predominantly a disease of female dogs.
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Affiliation(s)
- K J Nikula
- Collaborative Radiological Health Laboratory, Colorado State University, Fort Collins
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30
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McDougal WS, Koch MO. Phallic reconstruction during exenterative surgery for invasive urethral carcinoma. J Urol 1989; 141:1201-3. [PMID: 2709509 DOI: 10.1016/s0022-5347(17)41214-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A technique is described for phallic reconstruction after wide surgical excision of squamous cell carcinoma of the bulbomembranous urethra. Two cases in which this technique was used are presented with followup information at 9 and 12 months.
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Affiliation(s)
- W S McDougal
- Department of Urology, Vanderbilt University School of Medicine, Nashville, Tennessee
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31
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Abstract
Low stage female urethral carcinoma is curable by radiation therapy alone and is amenable to brachytherapy techniques whereby high doses of irradiation can be delivered safely. A 60 to 80 per cent 5-year survival rate with preservation of bladder function and control can be expected with good radiotherapeutic techniques. Except for stage Tis or early stage T1 lesions of the anterior urethra that can be treated with limited surgical excision, irradiation should be considered as an alternative to more extensive surgery for low stage bulky lesions. While there has been some success with radiation therapy alone for advanced disease, the cure rate probably can be improved with a combined approach using surgery, radiation therapy and possibly chemotherapy.
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Affiliation(s)
- S L Sailer
- Department of Radiation Medicine, Massachusetts General Hospital, Boston 02114
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32
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Abstract
The authors report a case of primary urethral carcinoma which seems to be linked to human papillomavirus (HPV) infection. Southern blot hybridization of phosphorus 32 (32P)-labeled DNA extracted from the cancer tissue gave a positive reaction with HPV-6. Specimens of the tumor material subjected to in situ hybridization with 3H-labeled HPV-6 DNA showed numerous tumor cell clusters with clearly labeled nuclei. Using immunoperoxidase staining the authors found papillomavirus structural antigen within cell nuclei of the tumor tissue.
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Abstract
The results of treatments for localized carcinoma of the urethra were assessed in 21 consecutive women treated at our institutions over a twenty year period. Only one of the tumors was confined to the distal urethra. Eighty-six percent invaded the periurethral tissues and 24% were known to be associated with regional lymph node metastases. Fifty-seven percent were adenocarcinomas. Five patients refused active therapeutic intervention and expired within one to 30 months following diagnosis. Sixteen patients were treated with extirpative surgery, radiation therapy, or combinations of the two. Four are free of disease at one, four, eleven, and 15 years after treatment. Nine developed pelvic recurrences, two developed pelvic recurrences and distant metastases and one developed distant metastases only from six to 72 months (mean, 19 months) after initial treatment. Eight of these 12 patients died at two to 13 months (mean, 8 months) after secondary treatment, two are alive with residual pelvic tumor, and two are clinically free of disease at 7 and 48 months. Only six patients were known to have distant metastases at the time of death and five of these six had adenocarcinomas. Advanced localized urethral cancer in women is difficult to eradicate and usually fatal.
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Mincione GP, Di Cello V, Nigi L, Durval A, Saltutti C. Grade 2 urethroprostatic papillary urothelial carcinoma with positive urinary cytology. J Urol 1985; 133:1038-9. [PMID: 3999205 DOI: 10.1016/s0022-5347(17)49369-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A rare case of papillary urothelial grade 2 carcinoma of the prostate and urethra in a patient with a previous papillary neoplasm of the bladder is reported. The tumor caused hematuria and prostatic enlargement suspicious for cancer. Urinary cytology was diagnostic.
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Shah AB, Kalra JK, Silber L, Molho L. Squamous cell cancer of female urethra. Successful treatment with chemoradiotherapy. Urology 1985; 25:284-6. [PMID: 3919484 DOI: 10.1016/0090-4295(85)90329-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report the case of a seventy-four-year-old woman with advanced squamous cell carcinoma of the urethra who achieved complete biopsy-proved regression of the tumor for more than thirty months after therapy with 5-fluorouracil, mitomycin-C, and radiotherapy.
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Abstract
Mucinous papillary adenocarcinoma of the bulbous urethra developed in a 40-year-old man with congenital stricture. The tumor appeared as a localized polypoid exophytic mass without evidence of submucosal invasion (Stage 0). The tumor was determined not to be of prostatic origin clinically and by absence of immunoperoxidase staining for prostatic acid phosphatase, prostate specific antigen, and carcinoembryonic antigen. Surgical resection of the urethra revealed extensive squamous and glandular metaplasia (urethritis glandularis) in association with the neoplasm. The mucosa displayed a spectrum of epithelial changes varying from dysplasia to carcinoma in situ, in confirmation of the urethral origin of the tumor. These observations emphasize the close association of metaplastic proliferative lesions and malignancy in the lower urinary tract.
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37
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Godec C, Anderson W, Cass A, Bates H. Urinary retention in female patients induced by adenocarcinoma of urethra. Urology 1984. [DOI: 10.1016/s0090-4295(84)90041-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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38
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Sufrin G, Meyer JS, Martin SA, Schechtman K. Proliferative activity of urothelium and tumors of renal pelvis, ureter, and urinary bladder evaluated by thymidine labeling. Urology 1984; 23:15-22. [PMID: 6367190 DOI: 10.1016/s0090-4295(84)80109-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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39
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Abstract
Carcinoma of the male urethra is infrequent. To date approximately 600 cases have been reported. We reviewed 16 cases of carcinoma of the male urethra seen at the University of Tennessee and the Memphis Veterans Administration Hospital. The mean patient age was sixty-three years (range 38 to 84). The most common presentation was a palpable mass followed by symptoms of urinary obstruction. Five urethral carcinomas arose distal to the suspensory ligament of the penis while 11 were of bulbar or bulbomembranous origin. The histology was squamous cell carcinoma in 8 patients (50%), mixed squamous and transitional cell carcinoma in 5 (31%), transitional cell carcinoma in 2 (13%), and adenocarcinoma in 1 (6%). The mean patient survival was fifteen months following diagnosis of a proximal urethral tumor and seventy-seven months for tumors arising distally. Neoplasms of the distal urethra can be surgically managed successfully even if regional lymph nodes are involved. The prognosis for proximal urethra tumors remains poor and is best treated by a combination of surgery and radiotherapy.
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40
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Abstract
Acquired polyps of the male urethra often present with hematuria and sometimes hemospermia. The histogenesis of these tumors has been debated. We report a case of a prostatic urethral polyp that proved to be of prostatic epithelial differentiation, as demonstrated by immunohistochemical identification of prostatic acid phosphatase and prostatic specific antigen within the tumor cells.
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41
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Chaitin BA, Manning JT, Ordóñez NG. Hematologic neoplasms with initial manifestations in lower urinary tract. Urology 1984. [DOI: 10.1016/0090-4295(84)90173-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Patanaphan V, Prempree T, Sewchand W, Hafiz MA, Jaiwatana J. Adenocarcinoma arising in female urethral diverticulum. Urology 1983; 22:259-64. [PMID: 6312661 DOI: 10.1016/s0090-4295(83)80009-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cancer arising from a female urethral diverticulum is rare, and because of its rarity, a review of the medical literature reveals significant nonuniformity in its management. We report an additional 2 cases of this disease, one of which has an even rarer feature of being mucin-producing. The management of our 2 cases is presented in detail and in line with the management of female urethral cancer. From our extensive literature search, diverticulectomy alone showed poor results with the highest rate of recurrence (67%). Extensive surgery, either in the form of cystourethrectomy or anterior exenteration, offered results comparable with those of combined therapy (diverticulectomy and full course of irradiation for early cases; preoperative irradiation followed by cystourethrectomy for late cases). Individualization of radiation treatment and cooperative effort between urologist and radiation oncologist are essential if best results are to be achieved.
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43
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Murphy WM, Fu YS, Lancaster WD, Jenson AB. Papillomavirus structural antigens in condyloma acuminatum of the male urethra. J Urol 1983; 130:84-5. [PMID: 6306287 DOI: 10.1016/s0022-5347(17)50968-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Current developments in the technology of viral identification have rekindled interest in the relationship of human papillomaviruses, condylomata acuminata and neoplasia. Although important observations are being reported in the female genital system the association of human papillomavirus and mucosal condylomata in male patients has not been well documented. Using the horseradish peroxidase technique and antisera to papillomaviruses, viral antigens were identified in 62 per cent of male patients with urethral condylomata acuminata. The implications of this relationship are discussed briefly.
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44
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Andrisani C, Tigano G, Visonà A. Su 4 Casi Dl Carcinoma Dell'Uretra Maschile. Urologia 1983. [DOI: 10.1177/039156038305000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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45
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Hopkins SC, Vider M, Nag SK, Tai DL, Soloway MS. Carcinoma of the female urethra: reassessment of modes of therapy. J Urol 1983; 129:958-61. [PMID: 6854768 DOI: 10.1016/s0022-5347(17)52482-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Of 15 women with primary urethral carcinoma 2 had tumors confined to the urethra and were managed successfully by an operation. Of the 9 patients with tumor extending to the surrounding structures 6 (67 per cent) died of complications related to inadequate control of the primary tumor. The last 4 patients had stage D1 disease or greater at initial diagnosis and died of distant metastases. Our current approach for patients with locally advanced disease is combined brachytherapy and operation in an effort to eradicate the primary tumor, since morbidity and mortality result from failure to control the local tumor.
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46
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Abstract
There is confusion over the type and nature of polypoid and papillary lesions of the prostatic urethra. These are uncommon growths which may present clinically with hematuria, frequency, obstruction or hematospermia. Pathologically, they usually occur in the region of the verumontanum and show papillary epithelial overgrowth. There is much variation in the terminology applied to such lesions, and many different theories of histogenesis have been advanced. Both benign and malignant lesions may occur. Two cases, one benign and one malignant, are described. The literature is reviewed and a rational nomenclature and histogenesis are proposed.
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47
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Abstract
The clinical and morphologic features in 29 cases of primary carcinoma of the female urethra were reviewed. Only 2 of 12 patients treated with radiotherapy are known to have failed; one is dead of disease at one year, and the other is alive with local recurrence at two years. We consider these results sufficiently satisfactory to warrant the continued use of radiotherapy in early-stage lesions, as well as in selected patients who have infiltrating carcinoma. Integrated therapy consisting of 5,000 rad/25 fractions/five weeks, followed in six weeks by radical cystourethrectomy, was used in 7 patients. The low morbidity and absence of operative mortality recommend continuation of this aggressive approach for infiltrating tumors in selected patients.
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48
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49
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Ghazizadeh M, Kagawa S, Kurokawa K. Specific red cell adherence testing of benign and malignant lesions of the urethra. J Urol 1982; 128:1188-9. [PMID: 7154169 DOI: 10.1016/s0022-5347(17)53414-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We herein report the first application of the specific red cell adherence test in patients with benign and malignant lesions of the urethra. In an attempt to determine whether the specific red cell adherence test could have potential use in predicting malignant behavior of urethral carcinoma we applied this test on specimens from 17 patients with a urethral caruncle, 3 with chronic urethritis and 4 with primary urethral carcinoma. Of the 20 benign lesions 18 (90 per cent) were positive for adherence, while the 4 urethral carcinoma specimens were negative. The high positive rate obtained in specimens of benign urethral lesions, together with the uniformly negative tests in those of urethral carcinoma, indicate the possible use of the specific red cell adherence test in early detection of aggressive behavior of urethral carcinoma, as well as predictiveness in bladder cancer.
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50
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Abstract
We report a case of transitional cell carcinoma of the anterior male urethra. Unlike squamous cell carcinoma of the anterior urethra, which usually requires partial penectomy, transitional cell carcinoma of this location can be managed with conservative local resection and preservation of the penis. Possible explanations for the origin of this lesion are discussed.
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