Pathology and natural history of urethral tumors in females: review of 65 cases

A Case of Urethral Metastasis from Sigmoid Colon Cancer Diagnostically and Prognostically Indicated by F-18 FDG PET/CT

Urethral metastasis from colorectal cancer is rare and is known to have a poor prognosis. A 72-year-old man with a history of colectomy and colostomy due to sigmoid colon cancer was admitted to the emergency room with bowel distension, rectal bleeding and urinary symptoms. Computed tomography of the abdominopelvis showed sigmoid colon cancer with multiple metastases involving the liver. Positron emission tomography with F-18 fluorodeoxyglucose (FDG) showed multiple hypermetabolic foci in the liver, penis and pubic bone, which otherwise could not be diagnosed. The lesions revealed no improvement with chemotherapy and urological surgery on follow-up F-18 FDG PET/CT. We present a case of urethral metastasis of sigmoid colon cancer diagnostically and prognostically indicated by F-18 FDG PET/CT.

Urethral Metastasis from a Colon Carcinoma

Urethral metastatic adenocarcinoma is rare. Only 9 such cases have been reported. We report a case of urethral metastasis from an ascending colonic adenocarcinoma. A 62-year-old man was diagnosed with Stage T4N0M0 ascending colon cancer. In September 2001, he underwent right hemicolectomy. In April 2004, he developed intermittent gross hematuria. Urethroscopy showed an exophytic tumor in the urethra, and biopsy revealed adenocarcinoma. Partial penectomy was performed. The pathologic examination showed moderately differentiated adenocarcinoma of the urethra consistent with the colonic primary. We describe the pathologic findings and immunohistochemical features of this case and briefly review the published reports.

Skene's Gland Adenocarcinoma Resembling Prostatic Adenocarcinoma

An 88-year-old woman presented with gross hematuria and a 3-cm periurethral mass. Biopsy revealed an adenocarcinoma resembling prostatic adenocarcinoma; the tumor cells were positive for keratin and prostate-specific antigen. The serum level of prostate-specific antigen was elevated; the carcinoembryonic antigen and CA-125 serum levels were normal. One year after external beam radiotherapy, the patient is without evidence of disease. This is the sixth case of a urethral prostatic-type adenocarcinoma, tumors that are most likely of Skene's gland origin.

Recurrence of sigmoid colon carcinoma in the residual urethra after cystectomy

INTRODUCTION

We report a case of recurrence of sigmoid colon cancer in the residual urethra after cysto-prostato-sigmoidectomy.

METHODS/RESULTS

The patient successfully underwent urethrectomy and is currently tumor-free. To our knowledge, this is the first case of recurrence of a non-urothelial malignant tumor in the residual urethra.

Metastasizing adenocarcinoma of the female prostate (Skene's paraurethral glands). Histological and immunohistochemical prostate markers studies and first ultrastructural observation

The case of a 46-year-old women with well-differentiated adenocarcinoma of the female prostate (Skene's paraurethral glands and ducts) with inguinal metastases is reported. Besides adenocarcinomatous structures, also more solid parts of the tumor and anaplastic regions with dark cells were found on histological examination. Clear cancerous cells were typical for glandular and solid tumor parts. The cancerous cells showed distinct immunohistochemical positivity of prostate specific antigen (PSA) and prostate (specific) acid phosphatase [P(S)AcP]. These are the first published results of electron microscopic examination of formalin fixed tissue showing the ultrastructure of female prostate carcinoma, comparable to that of the male prostate carcinoma. In the female, similar to the male, the prostate carcinoma probably originates from the secretory (luminal) cells of the female prostatic glands.

Prostate specific antigen and prostate specific acid phosphatase in adenocarcinoma of Skene's paraurethral glands and ducts

An autopsy case of adenocarcinoma of Skene's paraurethral gland co-incident with renal cell carcinoma is described. The adenocarcinoma showed distinct prostate specific antigen and prostate specific acid phosphatase pointing to the equivalence between the male prostate and Skene's paraurethral glands and ducts. Skene's gland are the homologue of the prostate in females and tumours arising from them are immunohistochemically similar to male prostate carcinoma.

Bladder sparing surgery for locally advanced female urethral cancer

Cystectomy remains one of the standard treatments for women with locally advanced (stage C) urethral cancer, or stage A or B lesions that have failed radiation therapy. Often, the urethral neoplasm does not invade the bladder. We treated 5 women with stage C urethral cancer by wide local excision with or without concomitant radiation therapy, while preserving the bladder. Local control was achieved in all patients with followup ranging from 4 to 75 months (median 42). We believe that bladder sparing treatment strategies should be considered for selected stage C tumors when the bladder is not invaded by the neoplasm.

Tumour of female paraurethral duct. Immunohistochemical similarity with prostatic carcinoma

A case of adenocarcinoma derived from a female paraurethral duct is described. Morphologically the tumour looked like a prostatic adenocarcinoma. Furthermore, the tumour cells stained positively with antibodies to prostatic specific antigen and prostatic specific acid phosphatase. The karyotype of the patient was 45,x/46,xx/47,xxx/46,xt(x;13)(p11;q22) demonstrating that the patient was not a hermaphrodite. The tumour therefore represented female homology of a prostatic adenocarcinoma.

Radiation therapy for primary carcinoma of the female urethra: a survey over 25 years

Sixty-two patients with primary carcinoma of the female urethra were treated with a combined radiation therapy (high-dose intracavitary vaginal radium and external beam). Treatment was strictly individualized, but an administered tumor dose of 5500-7000 rad (55-70 Gy) was always attempted. Forty-two patients (67.7%) had tumors of the anterior urethra, and in 20 women (32.3%) the posterior urethra was involved. In 19 patients (30.6%) the clinical diagnosis of lymph node involvement was made. The overall 5-year-survival rate was 64.5%. Patients with anterior urethral carcinoma had a higher 5-year-survival rate (71.4%) than patients with posterior carcinoma (50.0%). The favorable results underline the substantial role of radiation therapy for this malignancy.

Tumor of mesonephric origin in a diverticulum of the urethra. An ultrastructural study

A case of a rare tumor arising in a diverticulum of the urethra was studied. Light microscopy revealed the typical structures of mesonephric tumor with obvious infiltration of the muscularis. Electron microscopic appearance indicated that the tumor cells were immature and not totally characteristic of any tissue of origin. Apart from appearances suggesting rapid growth, cellular inclusions of various appearance were found.

Primary urethral neoplasms: review of 30 cases

The recent literature shows our findings on primary urethral neoplasms to be consistent with others, although we did not show an increased incidence of these neoplasms in female over male subjects. Similarly, we recommend an operation with or without irradiation, depending on the stage and location of the lesion. The over-all prognosis of urethral neoplasms remains poor. However, the distal urethral lesions in male and female subjects are easier to approach surgically and seem to be diagnosed earlier in the progression of this disease than the more proximally advanced tumors. These early staged and distal neoplasms greatly improve the changes of long survival. The delay in diagnosis gives this neoplasm its poor prognosis. In men the prognosis probably could be improved by more aggressive evaluation of stricture disease, especially when the need for dilation becomes frequent. In women we believe that the caruncle should be biopsied if it shows signs of progression or remains symptomatic (pain, bleeding and so forth). If a 1 to 2-month course of antimicrobials does not resolve this lesion we recommend biopsy. A relationship between tumor and a diverticulum has been noted in the literature, as in 1 of our cases of adenocarcinoma in a female patient. Whether this relationship could be explained on the basis of recurrent infection and stasis remains theoretical. In conclusion, early diagnosis, accurate staging and aggressive treatments are the means for cure of this disease.

Primary adenocarcinoma of female urethra associated with diverticula

Three cases of primary adenocarcinoma of the female urethra associated with diverticula are presented. Although the apparent risk of malignant change in urethral diverticula is low, such lesions are usually adenocarcinomas and may arise from urethritis glandularis, mesonephric rests, periurethral glands, or cloacogenic rests.