1
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Wong RWC, Talia KL, McCluggage WG. Gastric-type glandular lesions of the female genital tract excluding the cervix: emerging pathological entities. Histopathology 2024. [PMID: 38477341 DOI: 10.1111/his.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
In the last two decades or so, a spectrum of benign, premalignant and malignant cervical glandular lesions exhibiting gastric differentiation has been described, with gastric-type adenocarcinoma representing the most common human papillomavirus (HPV)-independent cervical adenocarcinoma. More recently, limited literature has reported a variety of gastric-type glandular lesions at other sites within the female genital tract and, as in the cervix (the most common site for these lesions), a spectrum of benign, premalignant and malignant lesions has been proposed. We provide an update and review of the emerging spectrum of gastric-type glandular lesions at female genital tract sites other than the cervix. In the endometrium, putative gastric-type glandular lesions include mucinous metaplasia of gastric-type, atypical mucinous proliferation of gastric-type and gastric-type adenocarcinoma. Similarly in the vagina, gastric-type adenosis, atypical adenosis and adenocarcinoma have been described. There have also been occasional reports of gastric-type lesions involving the ovary and fallopian tube. We provide guidance on how to recognise gastric-type lesions morphologically and immunophenotypically and stress that sometimes these lesions occur at more than one site within the female genital tract (synchronous/multifocal gastric-type lesions of the female genital tract), sometimes in association with Peutz-Jeghers syndrome.
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Affiliation(s)
- Richard W-C Wong
- Department of Pathology, United Christian Hospital, Kwun Tong, Hong Kong
| | - Karen L Talia
- Department of Pathology, Royal Children's Hospital and Royal Women's Hospital, Melbourne, Australia
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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2
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Lagarde-Lenon MS, Aron M. Reprint of: Female Urethral Carcinoma: A contemporary review of the clinicopathologic features, with emphasis on the histo-anatomic landmarks and potential staging issues. Hum Pathol 2023; 133:126-135. [PMID: 36894368 DOI: 10.1016/j.humpath.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 03/09/2023]
Abstract
Primary female urethral carcinoma (PUC-F) accounts for less than 1% of all genitourinary malignancies and comprises a histologically diverse group of tumors that are usually associated with poor prognosis. The carcinomas documented at this site include adenocarcinoma (clear cell adenocarcinoma, columnar cell carcinoma, and Skene gland adenocarcinoma), urothelial carcinoma (UCa), and squamous cell carcinoma (SCC). Recent studies have shown adenocarcinomas to be the most common type of primary urethral carcinoma in females. As most of the urethral carcinomas morphologically resemble carcinomas arising from surrounding pelvic organs or metastases, these should be ruled out before making the diagnosis of PUC-F. These tumors are currently staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. However, the AJCC system has limitations, including the staging of tumors involving the anterior wall of the urethra. Staging systems like the recently proposed histology-based female urethral carcinoma staging system (UCS) takes into account the unique histological landmarks of the female urethra to better stratify pT2 and pT3 tumors into prognostic groups, that correlate with clinical outcomes including recurrence rates, disease-specific survival and overall survival. Further larger multi-institutional cohorts are however required to validate the results of this staging system. There is very limited information regarding the molecular profiling of PUC-F. Thirty-one percent of clear cell adenocarcinomas have been reported to show PIK3CA alterations, whereas 15% of adenocarcinomas show PTEN mutations. Higher tumor mutational burden and PD-L1 staining have been reported in UCa and SCC. Although multimodality treatment is usually recommended in locally advanced and metastatic disease, the role of immunotherapy and targeted therapy is promising in select PUC-F cases.
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Affiliation(s)
- Maria Sarah Lagarde-Lenon
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA
| | - Manju Aron
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA.
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3
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Management of Primary Female Urethral Adenocarcinoma: Two Rare Case Reports and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010109. [PMID: 36676733 PMCID: PMC9865078 DOI: 10.3390/medicina59010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
Primary urethral adenocarcinoma in females is an extremely rare malignancy with unclear origin and only a few retrospective cases have been reported. The controversy continues to exist over the origin of primary urethral adenocarcinoma from periurethral glands (which include the Skene's glands), urethritis glandularis or intestinal metaplasia. Herein, we report one case of a 49-year-old female with distal urethral adenocarcinoma who presented with obstructive voiding. Abdominal and pelvic CT scans and chest radiology were unremarkable. Biopsy of the mass confirmed urethral adenocarcinoma. The patient underwent partial ureterectomy and was disease-free at the 2-years follow-up period. We also present another extremely rare case of primary urethral adenocarcinoma with mucinous features in a 58-year-old female who initially complained of external urethral orifice itching with painless urethral bleeding and was treated with local excision. The patient has not received any neoadjuvant or adjuvant therapy, and experienced tumor recurrence, inguinal lymph nodes metastasis, and even local iliopsoas metastasis during over 10-years follow-up. In conclusion, our current study emphasizes the importance of imaging studies and biopsy in making an accurate preoperative diagnosis of this rare disease, and further highlights the role of multimodal therapy. A combination of radiotherapy, chemotherapy and surgery is recommended for the optimal local and distant disease control. Moreover, better medical compliance and regular follow-up are required in these patients.
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4
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Snee(a)k Peek from Skene! INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00638-9] [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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5
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Lagarde-Lenon MS, Aron M. Female urethral carcinoma: a contemporary review of the clinicopathologic features, with emphasis on the histoanatomic landmarks and potential staging issues. Hum Pathol 2022; 129:71-80. [PMID: 36037997 DOI: 10.1016/j.humpath.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022]
Abstract
Primary female urethral carcinoma (PUC-F) accounts for less than 1% of all genitourinary malignancies and comprises a histologically diverse group of tumors that are usually associated with poor prognosis. The carcinomas documented at this site include adenocarcinoma (clear cell adenocarcinoma, columnar cell carcinoma, and Skene gland adenocarcinoma), urothelial carcinoma (UCa), and squamous cell carcinoma (SCC). Recent studies have shown adenocarcinomas to be the most common type of primary urethral carcinoma in females. As most of the urethral carcinomas morphologically resemble carcinomas arising from surrounding pelvic organs or metastases, these should be ruled out before making the diagnosis of PUC-F. These tumors are currently staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. However, the AJCC system has limitations, including the staging of tumors involving the anterior wall of the urethra. Staging systems like the recently proposed histology-based female urethral carcinoma staging system (UCS) takes into account the unique histological landmarks of the female urethra to better stratify pT2 and pT3 tumors into prognostic groups, that correlate with clinical outcomes including recurrence rates, disease-specific and overall survival. Further larger multi-institutional cohorts are however required to validate the results of this staging system. There is very limited information regarding the molecular profiling of PUC-F. Thirty-one percent of clear cell adenocarcinomas have been reported to show PIK3CA alterations, whereas 15% of adenocarcinomas show PTEN mutations. Higher tumor mutational burden and PD-L1 staining have been reported in UCa and SCC. Although multimodality treatment is usually recommended in locally advanced and metastatic disease, the role of immunotherapy and targeted therapy is promising in select PUC-F cases.
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Affiliation(s)
- Maria Sarah Lagarde-Lenon
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA
| | - Manju Aron
- Departments of Pathology and Urology, Keck School of Medicine, University of Southern California, 90033, USA.
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6
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Gao Q, Liu X, Ye L, Lv T, Teng Y, Lan J, Li T, Tian M, Chen J, He S, Xie S, Zou Y. Adenosquamous Carcinoma of Skene’s Gland: A Case Report and Literature Review. Front Oncol 2022; 12:893980. [PMID: 36016628 PMCID: PMC9396410 DOI: 10.3389/fonc.2022.893980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022] Open
Abstract
Skene’s gland is homologous to the male prostate and can secrete prostate fluid. However, Skene’s gland carcinoma is extremely rare, with only 20 cases reported in the literature thus far. We report the first case of adenosquamous carcinoma of Skene’s gland. The patient was a 54-year-old woman who was admitted to our hospital due to vaginal bleeding and a vaginal mass, accompanied by multiple lymph nodes and vulvar metastases. She had a history of dysuria and episodic hematuria for 2 years. Contrast-enhanced pelvic MRI showed a mass in the right labia majora and swelling of the right inguinal lymph nodes. In addition, a mass in the anterior vaginal wall surrounded the urethra and grew in a semi-encircled manner. After receiving neoadjuvant chemotherapy, MRI revealed that the mass surrounding the urethra had shrunk, and the nodular shadow of the right labia majora was larger than before. The patient underwent elective surgery. Surgical pathology showed adenosquamous carcinoma, and immunohistochemistry suggested intestinal differentiation. Forty-six days after surgery, the patient subsequently died of tumor consumption and organ insufficiency due to cerebral infarction, recurrence, and multiple metastases. This paper describes the clinical, radiological, and histopathologic features as well as the prognosis of the rare disease adenosquamous carcinoma of Skene’s gland. In addition, we briefly review the published literature.
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Affiliation(s)
- Qian Gao
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Xiaoyun Liu
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Lin Ye
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Tingting Lv
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Yanyi Teng
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Jian Lan
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Tingchao Li
- Department of Pathology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, China
| | - Min Tian
- Department of Pathology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, China
| | - Juqi Chen
- Department of Pathology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, China
| | - Shanshan He
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Shengyan Xie
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
| | - Yan Zou
- Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical University(The First People's Hospital of Zunyi), Zunyi, Guizhou, China
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7
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Slopnick EA, Bagby C, Mahran A, Nagel C, Garcia J, El-Nashar S, Hijaz AK. Skene's Gland Malignancy: A Case Report and Systematic Review. Urology 2022; 165:36-43. [PMID: 35192863 DOI: 10.1016/j.urology.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To present a recent clinical case of Skene's gland carcinoma and review all published literature of Skene's gland malignancy with associated treatment and outcomes. METHODS We review a new case of metastatic Skene's gland adenocarcinoma. We then performed a systematic search of PubMed and Ovid-Medline through December 2021 and retrieved English language articles for review. Peer-reviewed articles were deemed eligible if they included patients with Skene's gland malignancy. Reports were reviewed for pathologic accuracy, patient characteristics, clinical presentation, tumor pathology, treatment and outcome. RESULTS We reviewed 211 articles and included 15 cases from 1974 to 2022. The median patient age was 71 years (range 46-88). The most common presentation was an asymptomatic periurethral or urethral lesion in five cases (33.3%), followed by hematuria or vaginal bleeding in three patients (20.0%). In eight cases, a prostate-specific antigen was measured and found to be elevated, range 0.8-60.8 ng/mL. Treatment approaches varied and included local excision in eight cases, radical surgical resection in two cases, radiation therapy in two cases, and adjunctive androgen deprivation therapy in one case. Pathology was consistent with adenocarcinoma resembling prostate in all cases. In all cases tested, prostate-specific antigen normalized after definitive therapy of any type. Median follow up was 11.5 months, and there were no cases of recurrence or mortality secondary to Skene's gland adenocarcinoma. CONCLUSION There are 15 published cases of a Skene's gland malignancy, all adenocarcinoma resembling prostate. Local excision is most often utilized for treatment, with androgen deprivation therapy emerging as a new treatment consideration.
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Affiliation(s)
- Emily A Slopnick
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Christina Bagby
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Amr Mahran
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christa Nagel
- Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jorge Garcia
- Division of Solid Tumor Oncology, Department of Medical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Sherif El-Nashar
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
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8
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Maldarine JS, Sanches BDA, Santos VA, Góes RM, Vilamaior PSL, Carvalho HF, Taboga SR. The complex role of telocytes in female prostate tumorigenesis in a rodent model. Cell Biol Int 2022; 46:1495-1509. [PMID: 35598087 DOI: 10.1002/cbin.11816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 01/11/2023]
Abstract
The prostate is not an organ exclusive to the male. It is also found in females of several species, including humans, in which part of the Skene gland is homologous to the male prostate. Evidence is accumulating that changes in the stroma are central to tumorigenesis. Equally, telocytes, a recently discovered type of interstitial cell, are essential for the maintenance of stromal organization. However, it is still uncertain whether there are telocytes in the female prostate and if they play a role in tumorigenesis. The present study used ultrastructural and immunofluorescence techniques to investigate the presence of telocytes in the prostate of Mongolian gerbil females, a rodent model that often has a functional prostate in females, as well as to assess the impact of a combination of N-ethyl-N-nitrosourea, testosterone, and estradiol on telocytes. The results point to the presence of telocytes in the female prostate in the perialveolar and interalveolar regions, and reveal that these cells are absent in regions of benign and premalignant lesions in the gland, in which the perialveolar smooth muscle is altered. Additionally, telocytes are also closely associated with infiltrated immune cells in the stroma. Our data suggest that telocytes are important for both the maintenance of smooth muscle and prostatic epithelium integrity, which indicates a protective role against the advancement of tumorigenesis. But telocytes are also associated with immune cells and a proinflammatory/proangiogenic role for these cells cannot be ruled out, implying that telocytes have a complex role in prostatic tumorigenesis in females.
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Affiliation(s)
- Juliana S Maldarine
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Bruno D A Sanches
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Vitória A Santos
- Department of Biological Sciences, Laboratory of Microscopy and Microanalysis, Universidade Estadual Paulista-UNESP, São Paulo, Brazil
| | - Rejane M Góes
- Department of Biological Sciences, Laboratory of Microscopy and Microanalysis, Universidade Estadual Paulista-UNESP, São Paulo, Brazil
| | - Patricia S L Vilamaior
- Department of Biological Sciences, Laboratory of Microscopy and Microanalysis, Universidade Estadual Paulista-UNESP, São Paulo, Brazil
| | - Hernandes F Carvalho
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Sebastião R Taboga
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), São Paulo, Brazil.,Department of Biological Sciences, Laboratory of Microscopy and Microanalysis, Universidade Estadual Paulista-UNESP, São Paulo, Brazil
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9
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Padilla-Ansala C, García-Fernández E, González-Peramato P. Histopathological Subtypes and PD-L1 Expression in Primary Urethral Adenocarcinoma: A Series of 5 Cases. Int J Surg Pathol 2021; 29:488-495. [PMID: 33463392 DOI: 10.1177/1066896920988348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Urethral adenocarcinoma is a rare disease with poor prognosis that can display multiple histologic patterns and has an unclear histogenesis. Radical surgery with extensive periurethral resection is the preferred therapeutic approach. Both chemotherapy and radiotherapy have been used as complementary treatment options. Due to the tendency of these tumors to recur, treatment-associated complications, and the limited choice of therapeutic options, patient management can be difficult. Given the lack of literature regarding immunotherapy in urethral adenocarcinoma, our objective was to explore the expression of programmed death receptor-ligand 1 (PD-L1) throughout the different histological subtypes of primary urethral adenocarcinoma. METHODS We reviewed all primary urethral adenocarcinomas diagnosed at our hospital between 1965 and 2019, performed immunohistochemical assays on the tissue blocks, classified them according to their histology and origin, and performed PD-L1 (22C3) immunohistochemistry assays in all cases. RESULTS We found a total of 5 cases of primary urethral adenocarcinoma. All of the patients were women. One of the cases was a cribriform adenocarcinoma, 2 were columnar-mucinous adenocarcinomas, and 2 were clear cell adenocarcinomas. One of the clear cell adenocarcinomas strongly expressed PD-L1. In addition, a profuse inflammatory infiltration constituted by CD3-positive and CD8-positive T lymphocytes within tumor cells was observed in this case. None of the other cases showed PD-L1 expression. CONCLUSIONS In conclusion, some urethral adenocarcinomas may strongly express PD-L1 and thus could potentially allow the use of immunotherapy in selected cases of advanced or recurrent adenocarcinoma.
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Affiliation(s)
- Carlos Padilla-Ansala
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain.,Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Eugenia García-Fernández
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain.,Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Pilar González-Peramato
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain.,Pathology Department, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Desouki MM, Fadare O. Primary adenocarcinomas of the vulva and related structures: An enigmatic and diverse group of tumors ✰. Semin Diagn Pathol 2020; 38:71-84. [PMID: 33032903 DOI: 10.1053/j.semdp.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022]
Abstract
Approximately half of adenocarcinomas that involve the vulva are secondary, either through direct extension or metastases from elsewhere. Primary vulvar adenocarcinomas are rare and encompass a diverse array of neoplasms that are nominally classified based on the presumed tissue or organ of origin, the tumoral phenotype, or both. In this review, we summarize the clinicopathologic features of adenocarcinomas that originate from the vulva and related structures, including the terminal urethra. Adenocarcinomas of this region encompass lesions that are defined by their primary site (such as adenocarcinomas of the Bartholin gland, which by definition must be in the region of the Bartholin gland), histomorphology and immunophenotype (such as clear cell carcinoma and adenocarcinoma of intestinal [cloacogenic] type), or both (such as adenocarcinoma of skene gland origin, which is associated with that specific organ but which also displays a distinctive phenotype that is similar to the phenotype of high grade prostatic adenocarcinoma). Other types, such as mammary-type adenocarcinomas, are presumed to originate from the putative mammary-like glands of the vulva and display a spectrum of pathologic features that are similar to their mammary counterparts. Similarly, vulvar carcinomas of sweat gland origin are pathologically similar to their counterparts in the non-vulvar skin and include a variety of cutaneous adnexal-type malignancies such as apocrine adenocarcinoma and eccrine adenocarcinoma. Some tumors, such as adenoid cystic carcinoma, may represent a Bartholin gland adenocarcinoma, a carcinoma of sweat gland origin, or a carcinoma arising from extramammary Paget disease (EMPD), depending on the context. Invasive carcinomas of various types have been reported in 7-12.7% of EMPD, and these are likely the most common primary glandular malignancy of the vulva. Occasional vulvar adenocarcinomas have been reported to be HPV-associated, although this association has not been established for the broader group of vulvar adenocarcinomas. Rare adenocarcinomas are not classifiable by the aforementioned nosologic scheme, and are designated as vulvar adenocarcinoma NOS.
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Affiliation(s)
- Mohamed Mokhtar Desouki
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY; Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Department of Pathology, Microbiology and Immunology/University of South Carolina, Columbia, SC.
| | - Oluwole Fadare
- Department of Pathology, Anatomic Pathology Division, University of California San Diego Health, La Jolla, CA
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11
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Lenz J, Michal M, Michal M, Hes O, Konečná P, Lenz D. First Molecular Genetic Characterization of Skene's Gland Adenocarcinoma. Int J Surg Pathol 2020; 29:447-453. [PMID: 32795117 DOI: 10.1177/1066896920947808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary urethral adenocarcinomas are very rare neoplasms accounting for <10% of all urethral carcinomas. Site of their origin is unclear, but they seem to arise from Skene's paraurethral glands, which is the female homologue of the male prostate. The aim of this article is to report the first case of Skene's gland adenocarcinoma in which a molecular genetic profiling was performed. The patient was a 73-year-old woman with a polypoid lesion sized 3 × 2 cm located at the interface between the bladder neck and the proximal urethra. Transurethral resection was performed and small tissue fragments with positive margins were obtained. Histology revealed an epithelial neoplasm consisting of cribriform structures located in the subepithelial connective tissue of the bladder wall and proximal urethra. The lesion showed positive immunohistochemical staining with prostate specific antigen, prostatic acid phosphatase, NKX3.1, and alpha-methylacyl-CoA racemase. Using the Illumina TruSight Tumor 170 next-generation sequencing assay, a mutation and loss of heterozygosity of the phosphatase and tensin homologue (PTEN) gene was detected. No fusion in any of the examined genes was found using this assay as well as FusionPlex Solid Tumor Kit and FusionPlex Sarcoma kit assays from ArcherDX. Given the rarity of Skene's gland adenocarcinoma, it is uncertain whether the same grading and prognostic criteria that are currently used for prostatic cancer apply here as well. It is also unclear what treatment strategy should be applied, but according to the available literature, it seems that local excision or wide surgical resection could represent sufficient therapeutic modalities.
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Affiliation(s)
- Jiří Lenz
- Department of Pathology, 48246Znojmo Hospital, Czech Republic.,48384Cytohisto s.r.o., Breclav, Czech Republic.,Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic
| | - Michal Michal
- Department of Pathology, 60569Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd., Pilsen, Czech Republic
| | - Michael Michal
- Department of Pathology, 60569Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd., Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ondřej Hes
- Department of Pathology, 60569Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Bioptical Laboratory Ltd., Pilsen, Czech Republic
| | - Petra Konečná
- Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Czech Republic
| | - David Lenz
- 48384Cytohisto s.r.o., Breclav, Czech Republic
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12
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Maldarine JS, Sanches BDA, Cabral ÁS, Lima MLD, Guerra LHA, Baraldi CMB, Calmon MF, Rahal P, Góes RM, Vilamaior PSL, Taboga SR. Prenatal exposure to finasteride promotes sex-specific changes in gerbil prostate development. Reprod Fertil Dev 2020; 31:1719-1729. [PMID: 31248476 DOI: 10.1071/rd19106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/05/2019] [Indexed: 11/23/2022] Open
Abstract
Finasteride is a drug that is widely used in the treatment of benign prostatic hyperplasia, hair loss and even as a chemotherapeutic agent in the treatment of prostatic adenocarcinoma. However, its use is known to cause several side effects in adults and it can also cause changes in the embryonic development of the male prostate, which is a cause for concern given the possibility of the accumulation of finasteride in the environment. Nevertheless, no studies have investigated the effects of finasteride on the development of the prostate in females, which occurs in several species of mammals. To evaluate the effects of intrauterine exposure to finasteride (500μgkg-1 day-1) on postnatal prostate development in the Mongolian gerbil in the present study, we used immunohistochemistry, immunofluorescence, serological analysis and three-dimensional reconstruction techniques. Differences were observed in the effects of finasteride on periductal smooth muscle and cell proliferation between the sexes, as well as intersex differences in the presence of the androgen receptor, which was elevated in males, and the oestrogen receptor ERα, which was increased in females. Together, the data indicate that the female prostate has its own hormone dynamics and that there are sex-specific differences in the way in which the female prostate reacts to prenatal exposure to finasteride.
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Affiliation(s)
- Juliana S Maldarine
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), Bertrand Russel Avenue, 13083-862, Campinas, São Paulo, Brazil
| | - Bruno D A Sanches
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), Bertrand Russel Avenue, 13083-862, Campinas, São Paulo, Brazil
| | - Ágata S Cabral
- Department of Biology, São Paulo State University (UNESP), Laboratory of Genome Studies, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Maria L D Lima
- Department of Biology, São Paulo State University (UNESP), Laboratory of Genome Studies, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Luiz H A Guerra
- Department of Biology, São Paulo State University (UNESP), Laboratory of Microscopy and Microanalysis, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Carolina M B Baraldi
- Department of Biology, São Paulo State University (UNESP), Laboratory of Microscopy and Microanalysis, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Marília F Calmon
- Department of Biology, São Paulo State University (UNESP), Laboratory of Genome Studies, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Paula Rahal
- Department of Biology, São Paulo State University (UNESP), Laboratory of Genome Studies, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Rejane M Góes
- Department of Biology, São Paulo State University (UNESP), Laboratory of Microscopy and Microanalysis, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Patricia S L Vilamaior
- Department of Biology, São Paulo State University (UNESP), Laboratory of Microscopy and Microanalysis, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil
| | - Sebastião R Taboga
- Department of Structural and Functional Biology, Institute of Biology, State University of Campinas (UNICAMP), Bertrand Russel Avenue, 13083-862, Campinas, São Paulo, Brazil; and Department of Biology, São Paulo State University (UNESP), Laboratory of Microscopy and Microanalysis, Cristóvão Colombo Street, 2265, 15054-000, São José do Rio Preto, São Paulo, Brazil; and Corresponding author.
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Kaufman ME, Miller DT, Ullah A, White J, Singh G, Kolhe R, Williams H, Mittal P, Parikh J, Terris MK. Skene's Gland Adenocarcinoma: Borrowing From Prostate Cancer Experience for the Evaluation and Management of a Rare Malignancy. Urology 2020; 151:182-187. [PMID: 32504685 DOI: 10.1016/j.urology.2020.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/17/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine if adenocarcinoma of the Skene's glands in women, which has a histological and immunohistochemical appearance similar to prostate cancer, can be evaluated and managed with the same tools we use for prostate cancer. METHODS Serum prostate-specific antigen kinetics, 3D multiparametric (MP) magnetic resonance imaging (MRI), fluciclovine F-18 positron emission tomography (PET), and androgen deprivation therapy (ADT) were employed in a case of Skene's gland adenocarcinoma. RESULTS The 3D MP MRI clarified the anatomy of the primary lesion and fluciclovine F-18 PET significantly improved our ability to stage the tumor prompting pelvic lymph node dissection that may have otherwise not been performed. ADT resulted in a significant impact on prostate-specific antigen kinetics despite the patient having a testosterone level in the normal range for a postmenopausal woman. CONCLUSION Despite the rarity of Skene's gland adenocarcinoma, we can employ many of the tools at our disposal for the evaluation and management of prostate cancer to benefit the women found to have this malignancy.
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Affiliation(s)
- Matthew E Kaufman
- Section of Urologic Oncology, Augusta University Medical Center, Augusta, GA
| | - Devin T Miller
- Section of Gynecologic Oncology, Augusta University Medical Center, Augusta, GA
| | - Asad Ullah
- Department of Pathology, Augusta University Medical Center, Augusta, GA
| | - Joseph White
- Department of Pathology, Augusta University Medical Center, Augusta, GA
| | - Gurmukh Singh
- Department of Pathology, Augusta University Medical Center, Augusta, GA
| | - Ravindra Kolhe
- Department of Pathology, Augusta University Medical Center, Augusta, GA
| | - Hadyn Williams
- Department of Radiology, Augusta University Medical Center, Augusta, GA
| | - Pardeep Mittal
- Department of Radiology, Augusta University Medical Center, Augusta, GA
| | - Jigarkumar Parikh
- Section of Hematology/Oncology, Augusta University Medical Center, Augusta, GA
| | - Martha K Terris
- Section of Urologic Oncology, Augusta University Medical Center, Augusta, GA.
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Sanches BDA, Carvalho HF, Maldarine JS, Biancardi MF, Santos FCA, Vilamaior PSL, Taboga SR. Differences between male and female prostates in terms of physiology, sensitivity to chemicals and pathogenesis-A review in a rodent model. Cell Biol Int 2020; 44:27-35. [PMID: 31393043 DOI: 10.1002/cbin.11214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/04/2019] [Indexed: 01/24/2023]
Abstract
The prostate is a gland that is not exclusively present in males, being also found in females of several mammalian species, including humans. There is evidence that the prostate in both sexes is affected by the same pathologies such as prostatitis, benign alterations and even cancer. In view of the difficulties of manipulating the prostate gland, the Mongolian gerbil (Meriones unguiculatus), a rodent species with high incidence of functional prostates in females, is widely used in studies of the female prostate. However, despite knowing much about the similarities between the female and male prostate, little emphasis has been placed on the differences between them. This review investigates the intersex differences in prostate development, physiology and pathogenesis. The female prostate develops earlier than in males and studies indicate that it is more sensitive to oestrogens than the male prostate, as well as being more sensitive to exposure to xenoestrogens, such as Bisphenol A and methylparaben, with a higher susceptibility to benign lesions in the adult and senile prostate than in males. In addition, the female prostate is impacted by pregnancy and the oestrous cycle, and is also dependent on progesterone. The peculiarities of the female prostate raise concerns about the risk of it undergoing neglected changes as a result of environmental chemicals, since safe dosages are established exclusively for the male prostate.
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Affiliation(s)
- Bruno D A Sanches
- Department of Structural and Functional Biology, State University of Campinas-UNICAMP, Bertrand Russel Av., Campinas, São Paulo, Brazil.,Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil
| | - Hernandes F Carvalho
- Department of Structural and Functional Biology, State University of Campinas-UNICAMP, Bertrand Russel Av., Campinas, São Paulo, Brazil.,Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil
| | - Juliana S Maldarine
- Department of Structural and Functional Biology, State University of Campinas-UNICAMP, Bertrand Russel Av., Campinas, São Paulo, Brazil.,Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil
| | - Manoel F Biancardi
- Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil.,Department of Histology, Embryology and Cell Biology, Federal University of Goiás, Samambaia II, Goiânia, Goiás, 74001970, Brazil
| | - Fernanda C A Santos
- Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil.,Department of Histology, Embryology and Cell Biology, Federal University of Goiás, Samambaia II, Goiânia, Goiás, 74001970, Brazil
| | - Patricia S L Vilamaior
- Department of Structural and Functional Biology, State University of Campinas-UNICAMP, Bertrand Russel Av., Campinas, São Paulo, Brazil.,Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil
| | - Sebastião R Taboga
- Department of Structural and Functional Biology, State University of Campinas-UNICAMP, Bertrand Russel Av., Campinas, São Paulo, Brazil.,Laboratory of Microscopy and Microanalysis, Department of Biology, Universidade Estadual Paulista-UNESP, Cristóvão Colombo St., 2265, São José do Rio Preto, São Paulo, Brazil
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Staal J, Beyaert R. Inflammation and NF-κB Signaling in Prostate Cancer: Mechanisms and Clinical Implications. Cells 2018; 7:E122. [PMID: 30158439 PMCID: PMC6162478 DOI: 10.3390/cells7090122] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 12/26/2022] Open
Abstract
Prostate cancer is a highly prevalent form of cancer that is usually slow-developing and benign. Due to its high prevalence, it is, however, still the second most common cause of death by cancer in men in the West. The higher prevalence of prostate cancer in the West might be due to elevated inflammation from metabolic syndrome or associated comorbidities. NF-κB activation and many other signals associated with inflammation are known to contribute to prostate cancer malignancy. Inflammatory signals have also been associated with the development of castration resistance and resistance against other androgen depletion strategies, which is a major therapeutic challenge. Here, we review the role of inflammation and its link with androgen signaling in prostate cancer. We further describe the role of NF-κB in prostate cancer cell survival and proliferation, major NF-κB signaling pathways in prostate cancer, and the crosstalk between NF-κB and androgen receptor signaling. Several NF-κB-induced risk factors in prostate cancer and their potential for therapeutic targeting in the clinic are described. A better understanding of the inflammatory mechanisms that control the development of prostate cancer and resistance to androgen-deprivation therapy will eventually lead to novel treatment options for patients.
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Affiliation(s)
- Jens Staal
- VIB-UGent Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, VIB, 9052 Ghent, Belgium
- Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium
| | - Rudi Beyaert
- VIB-UGent Center for Inflammation Research, Unit of Molecular Signal Transduction in Inflammation, VIB, 9052 Ghent, Belgium.
- Department of Biomedical Molecular Biology, Ghent University, 9000 Ghent, Belgium.
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18
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Female Urethra Adenocarcinoma. Clin Genitourin Cancer 2018; 16:e263-e267. [DOI: 10.1016/j.clgc.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022]
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Intrauterine exposure to 17β-oestradiol (E2) impairs postnatal development in both female and male prostate in gerbil. Reprod Toxicol 2017; 73:30-40. [DOI: 10.1016/j.reprotox.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022]
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20
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Sanches BDA, Maldarine JS, Biancardi MF, Santos FCA, Pinto-Fochi ME, Antoniassi JQ, Góes RM, Vilamaior PSL, Taboga SR. Intrauterine exposure to oestradiol promotes sex-specific differential effects on the prostatic development of neonate gerbils. Cell Biol Int 2017; 41:1184-1193. [DOI: 10.1002/cbin.10829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/23/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Bruno D. A. Sanches
- Department of Structural and Functional Biology; State University of Campinas; Av. Bertrand Russel s/n Campinas São Paulo Brazil
| | - Juliana S. Maldarine
- Department of Biology, Laboratory of Microscopy and Microanalysis; Univ. Estadual Paulista − UNESP; Rua Cristóvão Colombo São José do Rio Preto São Paulo Brazil
| | - Manoel F. Biancardi
- Department of Structural and Functional Biology; State University of Campinas; Av. Bertrand Russel s/n Campinas São Paulo Brazil
| | - Fernanda C. A. Santos
- Department of Histology, Embryology and Cell Biology; Federal University of Goiás; Samambaia II Goiânia Goiás 74001970 Brazil
| | - Maria E. Pinto-Fochi
- Department of Biology, Laboratory of Microscopy and Microanalysis; Univ. Estadual Paulista − UNESP; Rua Cristóvão Colombo São José do Rio Preto São Paulo Brazil
| | - Julia Q. Antoniassi
- Department of Structural and Functional Biology; State University of Campinas; Av. Bertrand Russel s/n Campinas São Paulo Brazil
| | - Rejane M. Góes
- Department of Biology, Laboratory of Microscopy and Microanalysis; Univ. Estadual Paulista − UNESP; Rua Cristóvão Colombo São José do Rio Preto São Paulo Brazil
| | - Patrícia S. L. Vilamaior
- Department of Biology, Laboratory of Microscopy and Microanalysis; Univ. Estadual Paulista − UNESP; Rua Cristóvão Colombo São José do Rio Preto São Paulo Brazil
| | - Sebastião R. Taboga
- Department of Biology, Laboratory of Microscopy and Microanalysis; Univ. Estadual Paulista − UNESP; Rua Cristóvão Colombo São José do Rio Preto São Paulo Brazil
- Department of Biology, Laboratory of Microscopy and Microanalysis; São Paulo State University; 2265, Cristóvão Colombo Street, Jardim Nazareth São José do Rio Preto São Paulo 15054-000 Brazil
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Thum S, Haben B, Christ G, Sen Gupta R. Weibliches Prostatakarzinom? DER PATHOLOGE 2017; 38:448-450. [DOI: 10.1007/s00292-017-0322-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tubulosquamous polyps in the vagina. Immunohistochemical comparison with ectopic prostatic tissue and Skene glands. Ann Diagn Pathol 2016; 22:63-6. [DOI: 10.1016/j.anndiagpath.2016.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/11/2016] [Accepted: 04/04/2016] [Indexed: 11/21/2022]
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Recent Developments in Non-HPV-related Adenocarcinomas of the Lower Female Genital Tract and Their Precursors. Adv Anat Pathol 2016; 23:58-69. [PMID: 26645463 DOI: 10.1097/pap.0000000000000095] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most adenocarcinomas in the lower female genital tract (cervix, vagina, vulva) arise in the cervix and are associated with high-risk human papillomavirus (HPV) infection. However, there is an emerging spectrum of non-HPV-related cervical adenocarcinomas, the most common of which is so-called gastric type. In this review, the concept of gastric-type cervical adenocarcinomas and their possible precursor lesions is covered, the precursor lesions still being poorly understood. Other non-HPV-related cervical adenocarcinomas are also discussed, including new information regarding molecular events in mesonephric adenocarcinoma. A variety of primary vaginal adenocarcinomas, including clear cell, endometrioid, intestinal and gastric types are also discussed. The spectrum of benign and malignant glandular lesions involving the lower female genital tract and probably derived from misplaced Skene's (periurethral) glands is also covered.
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Abstract
The periurethral (Skene) glands may become involved by a variety of conditions. Mass-like lesions need to be distinguished from other lesions arising from the anterior vagina. Familiarity with these lesions will be helpful if a patient with a lesion of the Skene glands or periurethral region is encountered.
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Absence of Prostatic Growth in Large Cohort of Adult Female Patients with Congenital Adrenal Hyperplasia. J Urol 2012; 188:1588-95. [DOI: 10.1016/j.juro.2012.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 11/22/2022]
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Prostate-specific antigen response after definitive radiotherapy for Skene's gland adenocarcinoma resembling prostate adenocarcinoma. Urol Oncol 2012; 30:602-6. [DOI: 10.1016/j.urolonc.2010.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 06/29/2010] [Accepted: 06/29/2010] [Indexed: 11/17/2022]
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Primary vaginal mucinous adenocarcinoma of gastric type arising in adenosis: a report of 2 cases, 1 associated with uterus didelphys. Int J Gynecol Pathol 2012; 31:184-191. [PMID: 22317878 DOI: 10.1097/pgp.0b013e31822c8036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report 2 cases of primary vaginal mucinous adenocarcinoma arising in adenosis in nondiethylstilbestrol-exposed women, 1 with uterus didelphys. Both tumors exhibited morphologic and immunohistochemical features (MUC6 and/or HIK 1083 positivity) identical to the recently described cervical gastric-type adenocarcinoma, a subtype of mucinous adenocarcinoma that is non-human papillomavirus related and possibly related to adenoma malignum. Both neoplasms were intensely p53 positive, suggesting that TP53 mutation may be implicated in their development. We believe that the vaginal tumors arose from adenosis through atypical adenosis, as benign and atypical glands were present at the periphery of the neoplasms. In reporting these cases, we discuss atypical adenosis and other types of non-diethylstilbestrol-associated vaginal adenocarcinomas. At least 9 other examples of primary vaginal, or more uncommonly cervical, adenocarcinomas arising in non-diethylstilbestrol-exposed women with congenital genitourinary malformations have been reported, suggesting a probable causal association between congenital malformation, vaginal adenosis, and vaginal adenocarcinoma.
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Dietrich W, Susani M, Stifter L, Haitel A. The human female prostate-immunohistochemical study with prostate-specific antigen, prostate-specific alkaline phosphatase, and androgen receptor and 3-D remodeling. J Sex Med 2011; 8:2816-21. [PMID: 21810187 DOI: 10.1111/j.1743-6109.2011.02408.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The constitution of glands surrounding the human female urethra has been under debate; especially regarding as to what extent they equal the male prostate. Defining their composition may help to understand the development of neoplasms arising from this tissue. AIMS The aim of this study was to define the existence, structure, and arrangement of a possible human female prostate. METHODS Urethras of 25 women were investigated by immunohistochemistry and stained with specific monoclonal antibodies against prostate-specific antigen (PSA, mono- and polyclonal antibody), prostate specific alkaline phosphatase (PSAP), and androgen receptor (AR). From two urethras, which underwent a totally serial work up with PSA-staining, a three-dimensional model of the urethra and the prostatic glands was created to enable 3D-perception of the results. MAIN OUTCOME MEASURE The main outcome measures used in this study were identifying glandular structures in hematoxylin-eosin-staining, positive staining with the respective antibodies, and 3-D orientation of described glands. RESULTS Fourteen of 25 patients had glandular structures encircling the urethra. Twelve of 14 showed positive staining for PSA, PSAP, and AR in gland acini, while the excretory ducts, the urethra, and the surrounding stroma did not express those proteins. The strongest PSA and PSAP expression was found in apical cytoplasm of the glandular cells, and AR was confined to cell nuclei. Prostatic glands were located laterally to the distal half of the urethra. CONCLUSION A female prostate was found in every second woman in this study and can be discriminated from other urethral caverns and immature paraurethral ducts. Possible neoplasms of this source tissue expressing the prostate-specific markers may therefore be denominated as female prostate tumors.
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Affiliation(s)
- Wolf Dietrich
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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Prostatic-type Tissue in the Lower Female Genital Tract: A Morphologic Spectrum, Including Vaginal Tubulosquamous Polyp, Adenomyomatous Hyperplasia of Paraurethral Skene Glands (Female Prostate), and Ectopic Lesion in the Vulva. Am J Surg Pathol 2010; 34:950-5. [DOI: 10.1097/pas.0b013e3181e0f371] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chong Y, Eom M, Park KH, Chung HC, Ro JY. Adenofibroma of Skene's Duct: A Case Report. PATHOLOGY RESEARCH INTERNATIONAL 2010; 2010:318973. [PMID: 21152177 PMCID: PMC2997287 DOI: 10.4061/2010/318973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 01/28/2010] [Indexed: 11/20/2022]
Abstract
Skene's glands, also known as paraurethral glands, are homologues of the male prostate, in which painless cystic masses and inflammation due to obstruction have been rarely found and reported. In addition, there have been rare reported cases of adenocarcinoma of Skene's glands. Recently, the authors experienced the first case of adenofibroma arising in Skene's glands of a 62-year-old woman with coital pain. Hereby, we present the case with pathologic and immunohistochemical findings and a short review of literature.
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Affiliation(s)
- Yosep Chong
- Department of Pathology, Wonju College of Medicine, Yonsei University, 162 Ilsan-dong, Wonju, Gangwon-do 220-701, South Korea
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Moalem S, Reidenberg JS. Does female ejaculation serve an antimicrobial purpose? Med Hypotheses 2009; 73:1069-71. [DOI: 10.1016/j.mehy.2009.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/08/2009] [Indexed: 11/16/2022]
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Wimpissinger F, Tscherney R, Stackl W. Magnetic Resonance Imaging of Female Prostate Pathology. J Sex Med 2009; 6:1704-1711. [DOI: 10.1111/j.1743-6109.2009.01287.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cervical Adenocarcinoma In Situ Recurring as Vaginal Adenocarcinoma 16 Years After Hysterectomy. Int J Gynecol Pathol 2009; 28:296-300. [DOI: 10.1097/pgp.0b013e3181895592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wimpissinger F, Stifter K, Grin W, Stackl W. The Female Prostate Revisited: Perineal Ultrasound and Biochemical Studies of Female Ejaculate. J Sex Med 2007; 4:1388-93; discussion 1393. [PMID: 17634056 DOI: 10.1111/j.1743-6109.2007.00542.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Many speculations have been made on the possible existence of a "female prostate gland" and "female ejaculation." Despite several reports on the subject, controversy still exists around the "female prostate" and whether such a gland might be the source of fluid emitted during orgasm (ejaculation). AIM To investigate the ultrasonographic, biochemical, and endoscopic features in two women who reported actual ejaculations during orgasm. MAIN OUTCOME MEASURES Perineal ultrasound studies, as well as biochemical characteristics of ejaculate and urethroscopy, have been performed in two women. METHODS Two premenopausal women--44 and 45 years of age--who actually reported fluid expulsion (ejaculation) during orgasm have been investigated. Ultrasound imaging, biochemical studies of the ejaculated fluid, and endoscopy of the urethra have been used to identify a prostate in the female. Ejaculated fluid parameters have been compared to voided urine samples. RESULTS On high-definition perineal ultrasound images, a structure was identified consistent with the gland tissue surrounding the entire length of the female urethra. On urethroscopy, one midline opening (duct) was seen just inside the external meatus in the six-o'clock position. Biochemically, the fluid emitted during orgasm showed all the parameters found in prostate plasma in contrast to the values measured in voided urine. CONCLUSIONS Data of the two women presented further underline the concept of the female prostate both as an organ itself and as the source of female ejaculation.
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Abstract
We report 10 cases of a morphologically distinct vaginal polyp which has hitherto not been characterized. The polyps occurred in women aged 39 to 78 years (most were postmenopausal) and were from 1.0 to 3.0 cm. Most of whose location is known to us were in the upper vagina. Histologically, all the polyps were remarkably similar and composed of well-circumscribed expansile nests of epithelial cells embedded in a hypocellular fibrous stroma. The epithelial elements, which were morphologically bland, were predominantly glycogenated or nonglycogenated squamous in type but small tubules were present at the periphery of some of the nests in all cases. Some of the squamous nests exhibited central necrosis with or without calcification and, in 3 cases, some contained keratin pearls. In 3 cases, a few tubules unassociated with squamous elements were present. In 3 of 4 cases tested, the cells lining the tubules were positive with prostatic acid phosphatase and in 2 of 4 with prostate-specific antigen. The epithelial elements reacted with broad-spectrum cytokeratins and cytokeratin 7 but the mesenchymal component was negative. The squamous elements were estrogen receptor positive and the mesenchymal component estrogen and progesterone receptor positive. The histologic features of this polyp, which we term "tubulo-squamous polyp of the vagina," are constant and distinctive and differ from other polyps and from mixed tumor of the vagina. Several cases reported in the literature as vaginal mixed tumor or Brenner tumor are likely examples of this entity. Possible theories of histogenesis include a Mullerian origin, derivation from mesonephric remnants or derivation from urogenital sinus-derived epithelium. Positive staining in some cases with prostatic acid phosphatase and prostate-specific antigen raises the possibility of ectopic prostatic tissue, although the overall appearance is different from that entity, or derivation from paraurethral Skene glands, the female equivalent of prostatic glands in the male.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Royal Group of Hospitals Trust, Belfast, Northern Ireland.
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Abstract
Ectopic prostate tissue is a rare occurrence in the lower female genital tract. Possible theories of histogenesis include a developmental anomaly, metaplasia of preexisting endocervical glands, and derivation from mesonephric remnants. We report an example of prostatic tissue involving the uterine cervix of an 82-year-old woman as an incidental finding in a hysterectomy specimen. This unusual lesion should be differentiated from atypical glandular lesions of the cervix. Immunohistochemical studies confirm the histological suspicion of ectopic prostatic tissue.
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Affiliation(s)
- U Güth
- Frauenklinik, Universitäts-Spital Basel, Schweiz
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Kuroda N, Shiotsu T, Ohara M, Hirouchi T, Mizuno K, Miyazaki E. Female urethral adenocarcinoma with a heterogeneous phenotype. Case report. APMIS 2006; 114:314-8. [PMID: 16689832 DOI: 10.1111/j.1600-0463.2006.apm_345.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We here report a very rare case of female urethral adenocarcinoma. A 77-year-old woman presented with urinary retention. Cystoscopy showed a urethral tumor and the biopsy material showed adenocarcinoma. Macroscopically, the tumor measuring 3.0 x 3.0 x 2.4 cm was predominantly observed around the periurethral area on the proximal side. Histologically, patterns of columnar/mucinous adenocarcinoma, clear cell adenocarcinoma and papillary/micropapillary carcinoma were observed, but there was no evidence of a cribriform pattern. Immunohistochemically, neoplastic cells of at least one of three components were positive for CK7 and CK20 or CA125. We suggest that female urethral adenocarcinoma with a histologically and immunohistochemically heterogeneous phenotype may originate from cells within urethral or paraurethral tissue, such as urethritis glandularis or intestinal metaplastic epithelium and Mullerian tissue.
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Affiliation(s)
- N Kuroda
- Department of Pathology and Laboratory Medicine, Kochi Red Cross Hospital, Kochi, Japan
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McCluggage WG, Ganesan R, Hirschowitz L, Miller K, Rollason TP. Ectopic Prostatic Tissue in the Uterine Cervix and Vagina. Am J Surg Pathol 2006; 30:209-15. [PMID: 16434895 DOI: 10.1097/01.pas.0000180446.17517.b8] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prostatic tissue has rarely been described in the lower female genital tract. We describe 6 cases of ectopic prostatic tissue: 5 involving the cervix and 1 the vagina. The latter is the first reported example of benign prostatic tissue in the vagina. The age of the patients ranged from 21 to 65 years; and in all cases, the prostatic tissue was located within the cervical or vaginal stroma without involvement of the surface. In all cases, there were both glandular and squamous elements, which varied in prominence. In some cases, the squamous elements predominated to such an extent that the underlying glandular component was easily overlooked. In the glandular areas, a double cell layer of luminal and basal cells was focally apparent. There was little cytologic atypia or mitotic activity. Immunohistochemically, 3 of 6 cases were positive with prostate specific antigen (PSA) and all 6 cases marked with prostatic acid phosphatase (PSAP). In some of the positive cases, staining was focal. Positive staining with prostatic markers was confined to the glandular elements with no staining of the squamous areas. Immunohistochemical staining with the high molecular weight cytokeratin 34betaE12 highlighted the basal cell layer, which often extended into the center of the cellular islands, reminiscent of basal cell hyperplasia involving the prostate gland. All cases tested were CD10 positive (largely restricted to the basal cell layer), alpha-methylacyl-CoA racemase positive, and p16 negative. Estrogen receptor (ER) and progesterone receptor (PR) were negative in the glandular areas, but ER was positive in the squamous elements in all cases and PR was positive in 1 case. All cases tested were androgen receptor positive and exhibited a low MIB-1 proliferation index with only scattered positive nuclei. The presence of ectopic prostatic tissue in the lower female genital tract may be more common than is appreciated. Once the possibility is considered, the diagnosis is easily confirmed using immunohistochemistry, although staining with prostatic markers may be focal and PSA may be negative. Ectopic prostatic tissue in the lower female genital tract is almost certainly a benign condition, based on the morphology, including the presence of a double cell layer, although follow-up of larger numbers of cases is required. Possible theories of histogenesis include a developmental anomaly, metaplasia of preexisting endocervical glands, and derivation from mesonephric remnants.
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