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Huang Y, Wei L, Huang Y, Wen S, Liu T, Duan X, Wang Y, Zhang H, Fan B, Hu B. Identification of distinct genomic features reveals frequent somatic AHNAK and PTEN mutations predominantly in primary malignant melanoma presenting in the ureter. Jpn J Clin Oncol 2022; 52:930-943. [PMID: 35578896 DOI: 10.1093/jjco/hyac061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary malignant melanoma of the ureter is extremely rare. Genetic variants to the increased risk of developing the disease have not yet been investigated. METHODS Tumour mutation profiling for primary malignant melanoma of the ureter was performed by whole-exome sequencing. Immunohistochemistry was performed to verify histopathological features and the variants of predisposing genes and driver mutation genes. Furthermore, we conducted a literature review and Surveillance, Epidemiology and End Result-based study by searching public databases. RESULTS We identified 38 somatic single nucleotide variants and 9 somatic insertions and deletions (INDELs) in tumour specimens. After filtering with the Cancer Gene Census database, seven predisposing genes and two driver mutation genes were identified. Moreover, the immunohistochemical profile showed that tumour cells were positive for Melan-A, melanoma gp100 human melanoma black 45 (HMB45), S100 beta and P53. The expression levels of two driver mutation genes (phosphatase and tensin homolog (PTEN) and desmoyokin (AHNAK) and five predisposing genes (AT-rich interaction domain 1B (ARID1B), catalase, eukaryotic translation initiation factor 4 gamma 3 (EIF4G3), ANK3 and collagen type I) were significantly downregulated in tumour tissues compared to paracancerous tissues. In the literature review and Surveillance, Epidemiology and End Results-based study, patients with primary malignant melanoma of the urinary tract had worse clinical outcomes than patients with primary urothelial carcinoma after 1:2 propensity score matching (P = 0.010). Additionally, Cox multivariate analysis for patients with primary malignant melanoma of the urinary tract indicated that distant metastasis (hazard ratio = 1.185; P = 0.044) was an independent predictor for overall survival, and tumour focality (hazard ratio = 0.602; P = 0.017) and non-surgery (hazard ratio = 0.434; P = 0.003) were independent factors for tumour progression. CONCLUSIONS Our study is the first to provide evidence that the distinct phenotypes of primary malignant melanoma of the ureter may be due to different genetic variations. The prognosis of primary malignant melanoma of the urinary tract was poorer than that of primary urothelial carcinoma of the urinary tract.
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Affiliation(s)
- Yan Huang
- Department of Urology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Lai Wei
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, China
| | - Yuanbin Huang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shuang Wen
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Tianqing Liu
- Department of Pathology, Dalian Friendship Hospital, Dalian, Liaoning, China
| | - Xu Duan
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Yutong Wang
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Hongshuo Zhang
- Department of Biochemistry, Institute of Glycobiology, Dalian Medical University, Dalian, Liaoning, China
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bin Hu
- Department of Urology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
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Swartz MA, Porter MP, Lin DW, Weiss NS. Incidence of primary urethral carcinoma in the United States. Urology 2006; 68:1164-8. [PMID: 17141838 DOI: 10.1016/j.urology.2006.08.1057] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 05/29/2006] [Accepted: 08/11/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Primary urethral carcinoma is rare, and the demographic correlates of its incidence have not been examined using population-based data. METHODS The National Cancer Institute Surveillance, Epidemiology, and End Results database was used to identify persons diagnosed with primary urethral carcinoma from 1973 to 2002. During this period, the Surveillance, Epidemiology, and End Results program included population-based tumor registries in nine geographic areas that represented approximately 10% of the U.S. population. The incidence rates were tabulated for the major histologic subtypes according to age, sex, and race. RESULTS Primary urethral carcinoma was identified in 1075 men and 540 women, with an annual age-adjusted incidence rate of 4.3 per million and 1.5 per million, respectively. The annual incidence rate increased with age to a peak of 32 per million men and 9.5 per million women in the 75 to 84-year age group. The rate was 5.0 per million and 2.5 per million for African Americans and whites, respectively. The histologic types were transitional cell carcinoma in 888 patients (55%), squamous cell carcinoma in 348 (21.5%), and adenocarcinoma in 265 (16.4%). The incidence of the three primary histologic types varied by race and sex. CONCLUSIONS In the United States, the incidence of urethral carcinoma is relatively higher in men and African Americans, with a histologic profile differing from that previously described.
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Affiliation(s)
- Mia A Swartz
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Chitale SV, Szemere JC, Burgess NA, Sethia KK, Ball RY, Bardsley A. Surgical technique for the conservative management of distal urethral melanoma. ACTA ACUST UNITED AC 2001; 54:361-3. [PMID: 11355996 DOI: 10.1054/bjps.2000.3560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Urethral melanoma is very rare and pathological diagnosis is important. The prognosis remains poor irrespective of the treatment modality. Rare cases of long-term survival have been reported, one of them following conservative management. An initial attempt at conservative resection is worth considering to offer a better quality of life to the patient for as long as possible. We describe a technique of organ-sparing resection in the management of urethral melanoma along with the follow-up protocol that we adapted.
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Affiliation(s)
- S V Chitale
- Departments of Urology, Norfolk and Norwich Hospital, Norwich, UK
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Oliva E, Quinn TR, Amin MB, Eble JN, Epstein JI, Srigley JR, Young RH. Primary malignant melanoma of the urethra: a clinicopathologic analysis of 15 cases. Am J Surg Pathol 2000; 24:785-96. [PMID: 10843280 DOI: 10.1097/00000478-200006000-00003] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinical and pathologic features of 15 primary urethral melanomas occurring in patients (nine women and six men) age 44 to 96 years (mean age, 73 yrs) are described. In the men the tumor involved the distal urethra. In eight women it involved the distal urethra, usually the meatus; both the distal and proximal urethra were involved in one woman. The tumors were typically polypoid and ranged from 0.8 to 6 cm (mean, 2.6 cm) in maximum dimension. A vertical growth phase was present in all tumors, with a prominent nodular component in seven of them. A radial growth phase was seen in nine tumors. The depth of invasion ranged from 2 to 17 mm. The tumors had diffuse, nested, storiform, or mixed growth patterns. The neoplastic cells typically had abundant eosinophilic cytoplasm, large nuclei with prominent nucleoli, and brisk mitotic activity. Melanin pigment was seen in 12 tumors but was conspicuous in only six. At the time of diagnosis, 13 tumors were confined to the urethra and two patients had lymph node metastasis. Nine patients died of disease 13 to 56 months after initial diagnosis and treatment, and one patient had a local recurrence at 4 years and subsequently died of sepsis 1 year later. Three patients were alive and well at 11 months, 23 months, and 7 years. One patient died at the time of the initial operation, and one died of a ruptured aortic aneurysm at 3 years without evidence of melanoma at autopsy. Primary malignant melanomas of the urethra, one fifth of which are amelanotic, must be included in the differential diagnosis of a number of primary neoplasms that involve the urethra, including transitional cell carcinoma, sarcomatoid carcinoma, and sarcomas. Conventional prognostic factors, such as depth of invasion or tumor stage, do not seem to play as important a role in predicting survival as the mucosal location and the nodular growth present frequently in these tumors.
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Affiliation(s)
- E Oliva
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston 02114, USA
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Dinney CP, Johnson DE, Swanson DA, Babaian RJ, von Eschenbach AC. Therapy and prognosis for male anterior urethral carcinoma: an update. Urology 1994; 43:506-14. [PMID: 8154072 DOI: 10.1016/0090-4295(94)90242-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The scarcity of reports evaluating the effect of current treatment strategies for male urethral carcinoma has prompted a review of our recent experience. Since our last report (1980), we have seen 23 patients with this disease. METHODS We performed a retrospective chart review of 23 patients seen in our institution between 1979 and 1990 with this type of cancer. RESULTS Fifty-two percent of our patients are alive without evidence of disease, after a mean follow-up of fifty months (range, 5 to 156 months). Treatment analysis indicates that distal urethrectomy and partial penectomy are adequate in controlling local disease for tumors arising in the fossa navicularis and penile urethra, respectively, and that en bloc excision of the penis, scrotum, prostate, and bladder together with resection of the inferior pubic rami, using myocutaneous flaps to cover the surgical defect, can provide long-term disease-free survival for patients whose tumor originates in the bulbomembranous urethra. Use of cisplatin-based chemotherapy resulted in a prolonged survival for patients who presented with metastatic disease. CONCLUSIONS We conclude that the prognosis for patients with urethral carcinoma has improved, and some of the patients are having a prolonged disease-free survival due, in part, to more effective local and regional control and improved chemotherapy.
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Affiliation(s)
- C P Dinney
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston
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Rashid AM, Williams RM, Horton LW. Malignant melanoma of penis and male urethra. Is it a difficult tumor to diagnose? Urology 1993; 41:470-1. [PMID: 8488617 DOI: 10.1016/0090-4295(93)90511-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two cases of malignant melanoma of the penis and male urethra are presented in which the diagnosis was difficult to make clinically and histopathologically. Our findings support the general opinion that melanomas at this site have a poor prognosis.
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Affiliation(s)
- A M Rashid
- Department of Histopathology, Royal Berkshire Hospital, Reading, United Kingdom
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Abstract
A case of primary malignant melanoma of the male urethra is reported. Treatment included partial urethrectomy, bilateral inguinal and iliac lymphadenectomy, and post-surgical systemic chemotherapy. After thirty-six months, the patient is alive with cutaneous, pelvic lymph node, and gastric metastases.
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Affiliation(s)
- L Calcagno
- Division of Urology, Galliera Hospital, Genoa, Italy
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Abstract
Primary malignant melanoma of the male urethra is a rare disease, with only 24 cases previously reported in the literature, including 1 black patient. We describe 2 additional patients with primary malignant melanoma of the urethra, one of whom was a black man. The literature is reviewed briefly and treatment recommendations are discussed.
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Affiliation(s)
- J M Pow-Sang
- Department of Surgery, University of Florida College of Medicine, Gainesville
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Il Tumore Primitivo Dell'Uretra Prostatica. Urologia 1987. [DOI: 10.1177/039156038705400516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Nine cases of primary malignant melanoma of the penis and male urethra are presented. The age range of the patients was 57-77 years. Five patients had intermittent bleeding, one had pain, and three were asymptomatic. Six patients had the melanoma on the glans or prepuce and three in the urethra; two presented with inguinal lymph node metastases. Penile amputation was performed in six patients, local excision in three, groin dissection in four, and one was given radiotherapy. Postoperative metastases were seen in eight patients, four of whom were treated with surgery, alone or in combination with radiotherapy, and one with chemotherapy. Two patients are still living, at 2 and 14 years after diagnosis, respectively. Seven patients have died of their tumors, five of them within 2 years. This confirms the consensus of available reports that, irrespective of what type of therapy is used, prognosis is poor in patients with malignant melanoma of the penis and urethra.
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Sanders TJ, Venable DD, Sanusi ID. Primary malignant melanoma of the urethra in a black man: a case report. J Urol 1986; 135:1012-4. [PMID: 3959227 DOI: 10.1016/s0022-5347(17)45962-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report a unique occurrence of primary urethral melanoma in a black man. The biological relationships to melanocyte/melanin site densities or to precursor mucosal lesions are discussed as possible etiological factors in the occurrence of this rare neoplasm.
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Abstract
Nephrogenic metaplasia is an uncommon sequela of chronic bladder irritation. The case described herein represents the second reported in the bulbomembranous urethra of the male. Important questions are raised regarding the premalignant potential of nephrogenic metaplasia. A review of the literature on adenocarcinoma of the male urethra and also of nephrogenic metaplasia of the bladder and urethra is presented.
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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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Abstract
Carcinoma of the deep male urethra is a rare disease. Conservative measures yielding dismal outcomes were standard until 1957, with the report of an 80 per cent five-year survival rate after radical surgery. To assess the value of this surgery, we reviewed all cases of carcinoma of the deep male urethra managed at UCLA Medical Center and its affiliated hospitals between 1952 and 1980. Of the patients managed with radical surgery, 1 died of a myocardial infarction between staged surgical procedures, and 5 died of their disease between twelve and fifty-two months postoperatively (mean survival, 26 months). There were 2 long-term disease-free survivors, yielding a survival rate of 25 per cent. We have also compiled the results of all major series dealing with deep urethral carcinoma published subsequent to the 1957 report. This review of the literature supports the concept that radical extirpative surgery is mandatory in the management of carcinoma of the deep male urethra.
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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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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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Bans LL, Eble JN, Lingeman JE, Maynard BR. Transitional cell carcinoma of the fossa navicularis of the male urethra. J Urol 1983; 129:1055-6. [PMID: 6854754 DOI: 10.1016/s0022-5347(17)52539-2] [Citation(s) in RCA: 12] [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
We report a case of transitional cell carcinoma arising in the fossa navicularis, a portion of the male urethra ordinarily lined by squamous epithelium. This is the third reported case of transitional cell carcinoma of the distal urethra. The neoplasm metastasized to superficial inguinal lymph nodes.
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Abstract
Primary urethral melanoma in male subjects is rare and optimum therapy has not been established. We described a male patient with a primary urethral melanoma that arose in a precursor nevus and was treated by excision, bilateral groin dissections and postoperative radiation therapy. Urinary and sexual functions have been maintained. We review the previously reported cases of urethral melanoma in male subjects. The biologic relationship of melanoma to precursor lesions in mucosal sites is discussed.
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Abstract
A case of primary adenosquamous carcinoma of the urethra observed in a 52 year old man is described. The patient had a history of recurrent scrotal abscess for seven and one-half months following trauma to the region. The serum calcium level was found to be elevated when carcinoma was diagnosed. The calcium level returned to normal after resection of the lesion but rose again when local recurrence and metastasis developed. He died three and one-half months after the surgery.
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Silverman ML, Eyre RC, Zinman LA, Corsson AW. Mixed mucinous and papillary adenocarcinoma involving male urethra, probably originating in periurethral glands. Cancer 1981; 47:1398-402. [PMID: 6261924 DOI: 10.1002/1097-0142(19810315)47:6<1398::aid-cncr2820470626>3.0.co;2-s] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The case of a patient with primary adenocarcinoma involving the urethra is described. Morphologic evidence supporting an origin in the periurethral glands is presented. The urologist and pathologist must maintain a high index of suspicion in evaluating patients with urethral structure or urethrocutaneous fistulae because superficial transurethral biopsy may fail to obtain adequate depth to demonstrate malignancy.
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Abstract
Between 1965 and 1977, 8 men with low grade urethral neoplasms were treated with local excision or a combination of local excision and local chemotherapeutic agents. The tumors were in the anterior urethra in 5 cases and the posterior urethra in 3. Histology included 2 transitional cell papillomas, 3 squamous cell carcinomas, 1 transitional cell carcinoma, 1 mesonephric carcinoma and 1 intraductal transitional cell carcinoma in situ. All neoplasms were controlled by local measures for 1 to 13 years. This experience suggests that local treatment may be an acceptable alternative to a radical operation in certain well localized low grade urethral neoplasms in men.
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Leissner KH, Johansson S. Topical application of 5-fluorouracil cream: a therapeutic alternative in the treatment of urothelial tumours of the distal urethra. A case report. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1980; 14:115-8. [PMID: 7375834 DOI: 10.3109/00365598009181202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A case of secondary urothelial tumour of the distal male urethra is presented. The tumour was successfully treated by local application of 5-Fluorouracil cream. No side-effects were observed. Repeated topical applications of 5-Fluorouracil may be a therapeutic alternative to surgical treatment of urothelial urethral tumours.
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Abstract
We reviewed 23 cases of primary carcinoma of the male urethra and compared the clinical findings, treatment and results to the experiences previously reported. Patients with lesions of the pendulous urethra managed by appropriate amputation of the penis with ilio-inguinal node dissection for groin metastases had a good prognosis, whereas patients with lesions of the bulbo-membranous or prostatic urethra had a poor prognosis. Despite occasional successful results with conservative surgical excision and over-all poor results with radical excision the generally extensive nature of such tumors necessarily makes radical excision the treatment of choice.
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Abstract
Malignant melanoma of the penis and male uretha are unusually aggressive tumors which only rarely are cured by radical surgery. Melanosis of the penis may be confused with malignant melanoma, and we report a case of melanosis originally diagnosed and treated as melanoma with survival for twenty years. We contrast this with another case of malignant penile melanoma with a fatal outcome.
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Sacks SA, Waisman J, Apfelbaum HB, Lake P, Goodwin WE. Urethral adenocarcinoma (possibly originating in the glands of Littre). J Urol 1975; 113:50-5. [PMID: 1113396 DOI: 10.1016/s0022-5347(17)59405-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Adenocarcinoma involving the bulbomenbranous urethra is a rare disease. This disease is describe in a 30-year-old man and the surgical management is detailed. The adenocarcinoma described seems to have arisen from the periurethral glands of littre. Despite the radical nature of the tumor excision, it was possible to spare the distal penis in order to achieve a more normal appearance of the external genitalia.
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Bracken RB, Diokno AC. Melanoma of the penis and the urethra: 2 case reports and review of the literature. J Urol 1974; 111:198-200. [PMID: 4810764 DOI: 10.1016/s0022-5347(17)59926-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Girgis AS, Bergman H, Rosenthal H, Solomon L. Unusual penile malignancies in circumcised Jewish men. J Urol 1973; 110:696-702. [PMID: 4757555 DOI: 10.1016/s0022-5347(17)60318-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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