Primary signet ring cell carcinoma of female urethra

Morphologic spectrum of the epithelial tumors of the male and female urethra

The classification of the epithelial tumors of the male and female urethra includes benign and malignant neoplasms. Primary urethral carcinomas and adenocarcinomas of the accessory glands are the most relevant tumors, both from the morphologic and clinical point of view. An accurate diagnosis, grading and staging are essential for determining adequate treatment strategies and outcome. Information on anatomy and histology of the urethra is of fundamental importance in understanding the morphology of the tumors, including the clinical importance of their location and origin.

CDX2- and PAX8-Expressing Subtypes in Female Urethral Adenocarcinoma: Pathogenesis Insights through Immunohistochemical and Morphological Analyses

Female urethral adenocarcinoma has attracted attention as a rare tumor type based on its differential pathogenesis from its male counterpart. However, to date, our knowledge concerning its immunohistochemical and morphological characteristics remains limited due to the small number of cases studied. In this study, nine consecutive cases of female urethral adenocarcinoma were used for immunohistochemical and morphological characterization of the tumor based on semi-comprehensive immunohistochemical analysis and detailed morphological evaluations. Our immunohistochemical assay revealed two subtypes of female urethral adenocarcinoma with distinctive staining patterns: the CDX2- and PAX8-expressing subtypes. The former stained positive for other intestinal markers (e.g., HNF4α and TFF1) as well (7 of 7 cases); the latter stained negative for these intestinal markers (0 of 2 cases) but stained positive for clear cell carcinoma markers (e.g., Napsin A and HNF1β) (2 of 2 cases). Regarding cytokeratins, the former displayed a CK7- and CK20-positive immunoprofile (7 of 7 cases); the latter exhibited a CK7-positive and CK20-negative immunoprofile (2 of 2 cases). Morphologically, CDX2- and PAX8-expressing subtypes resembled intestinal-type adenocarcinoma and clear cell carcinoma (occurring in gynecological organs), respectively. The semi-comprehensive immunoprofiling data presented in this study can potentially contribute to the correct diagnosis of this rare tumor type. Finally, our study represents an important basis for future investigations aiming to further elucidate the details and origin of female urethral adenocarcinoma, and it can potentially contribute to developing diagnostic and therapeutic strategies for treating this malignancy.

Carcinoma of the urethra

Primary carcinomas of the urethra are rare and poorly understood lesions; hence, their clinical and pathologic spectrum is not completely defined. We analyzed a series of 130 primary urethral tumors and classified 106 of them as primary urethral carcinomas. The age at diagnosis of patients with primary urethral carcinomas ranged from 42 to 97 years (mean, 69.4 years; median, 70 years). There were 73 male and 33 female patients with a ratio of 2.2:1. In male patients, the tumors most frequently developed in the bulbous-membranous segment of the urethra. In female patients, the entire length of the urethra was typically involved. Microscopically, they were poorly differentiated carcinomas with hybrid squamous and urothelial features and developed from precursor intraepithelial conditions such as dysplasia and carcinoma in situ, which were frequently present in the adjacent urethral mucosa. High-risk human papilloma virus infection could be documented in 31.6% of these tumors. Follow-up information was available for 95 patients. Twenty-three patients died of the disease with a mean and median survival of 39 and 21 months, respectively. Urethral carcinomas are aggressive tumors with a high propensity for regional and distant metastases with mean and median survival of 39 and 21 months, respectively. Our observations have important implications for the management of patients with primary carcinoma of the urethra by defining them as a unique entity linked to human papilloma virus infection.

Signet ring adenocarcinoma of a urethral diverticulum

Urethral diverticula are a rare entity. Carcinoma in a urethral diverticulum is a particularly unusual finding with only a little over 200 cases in the reported literature. Adenocarcinoma is the most common carcinoma to occur in a urethral diverticulum. To our knowledge, there are only a handful of cases of signet ring cell adenocarcimona of the urethra and no cases of signet ring adenocarcinoma found in a urethral diverticulum. We present a case report of an incidentally found signet ring cell adenocarcinoma of a female urethral diverticulum.

Urethral carcinoma: critical view on contemporary consecutive series

Urethral carcinoma is a rare cancer of the urinary tract. Although most cases are of squamous cell carcinomas, there are several reports in the literature about transitional cell carcinoma and adenocarcinomas whose origin remains controversial. While the diagnosis of this condition is essentially clinical, magnetic resonance imaging (MRI) is the examination of choice for its staging, and a pathological confirmation is still necessary. There is no consensus on the treatment of these tumors because of its low incidence. The following therapeutic options are currently available: surgical resection (often for small and distal urethral tumors); radiotherapy and chemotherapy, for larger tumors, seeking a functional preservation of the penis, bladder and/or vagina; or a combination of these therapies thereof in case of more extensive tumors. The classic treatment involves surgery aiming loco-regional disease control, and continent urinary derivation provides satisfactory functional results in cases of radical urethrectomy. Much still needs to be learned about urethral cancer, and molecular diagnostics tools and therapeutic targets are promissory. The key to better understanding urethral cancer is the pooling of data from a wide range of sources including international consortia.

Urachal signet-cell adenocarcinoma

This report presents two cases of urachal signet-cell adenocarcinoma (USCA). Two men, aged 53 and 51 years, presented with haematuria. Cystoscopy showed tumours in the dome of the bladder and transurethral resection revealed signet ring cell carcinoma. They both underwent cystoprostatectomy but died of metastatic disease after 14 and 26 months. USCA is a very rare tumour with poor prognosis. Only 25 cases have been reported. The tumours have a specific gross and microscopic morphology but must be distinguished from metastases of signet ring cell originating from other sites. Immunohistochemistry is helpful for the determination of the primary site.

Recurrencia de un carcinoma gástrico de células en anillo de sello demostrada por PET-FDG

OBJECTIVE

To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease.

MATERIALS AND METHODS

The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease.

RESULTS

FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later.

CONCLUSIONS

In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG.