1
|
Liao RS, Ruan HT, Jang A, Huynh M, Nadal Rios R, Hoffman-Censits JH, Wei S, Mian OY, Barata PC. Emerging Insights in Small-Cell Carcinoma of the Genitourinary Tract: From Diagnosis to Novel Therapeutic Horizons. Am Soc Clin Oncol Educ Book 2024; 44:e430336. [PMID: 38176691 DOI: 10.1200/edbk_430336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Small-cell carcinomas (SCCs) of the genitourinary (GU) tract are rare malignancies with high metastatic potential. The most common primary sites are the bladder and prostate, but case reports of primary SCC of the kidney, ureter, and urethra also exist. The majority of patients present with gross hematuria, irritative or obstructive urinary symptoms, and symptoms of locoregionally advanced or metastatic disease at initial presentation. SCC of the bladder presents with nodal or metastatic involvement in the majority of cases and requires the use of platinum-based chemotherapy in combination with surgery and/or radiation. SCC of the prostate is most commonly seen in the metastatic castrate-resistant setting, and aggressive variant disease presents with a greater propensity for visceral metastases, osteolytic lesions, and relatively low serum prostate-specific antigen for volume of disease burden. Multiple retrospective and prospective randomized studies support the use of a multimodal approach combining platinum-based systemic therapy regimens with radiation and/or surgery for localized disease. This evidence-based strategy is reflected in multiple consensus guidelines. Emerging data suggest that small-cell bladder and prostate cancers transdifferentiate from a common progenitor of conventional urothelial bladder carcinoma and prostatic acinar adenocarcinoma, respectively. Areas of active basic research include efforts to identify the key genetic and epigenetic drivers involved in the emergence of small cell cancers to exploit them for novel therapies. Here, we review these efforts, discuss diagnosis and currently supported management strategies, and summarize ongoing clinical trials evaluating novel therapies to treat this rare, aggressive GU cancer.
Collapse
Affiliation(s)
- Ross S Liao
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, OH
| | - Hui Ting Ruan
- Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | - Albert Jang
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Melissa Huynh
- Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | | | | | - Shuanzeng Wei
- Fox Chase Cancer Center, Department of Pathology, Philadelphia, PA
| | - Omar Y Mian
- Cleveland Clinic Foundation, Case Comprehensive Cancer Center, Cleveland, OH
| | - Pedro C Barata
- University Hospitals Seidman Cancer Center, Cleveland, OH
| |
Collapse
|
2
|
Miki K, Fujita K, Kuwahara K, Adomi S, Minami T, Nozawa M, Yoshimura K, Kojima M, Maenishi O, Uemura H. A case of neuroendocrine tumor at the external urethral meatus after total cystectomy. IJU Case Rep 2023; 6:424-427. [PMID: 37928310 PMCID: PMC10622219 DOI: 10.1002/iju5.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/25/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction The histological types of urethral cancer are mainly squamous cell or transitional cell carcinoma. Neuroendocrine tumor is extremely a rare type of urethral cancer. Case presentation A 72-year-old man visited with an erythema at the external urethral meatus. After 3 months, a 1-cm reddish solid tumor was found on the external urethral meatus. He had a history of bladder cancer (pTa with carcinoma in situ), including the prostatic urethra, and underwent radical cystectomy with urethrectomy and ileal conduit construction 11 years ago. After 3 months, a 1-cm reddish solid tumor was found on the external urethral meatus. The pathological diagnosis was a neuroendocrine tumor. Partial penectomy was performed. Conclusion Small cell neuroendocrine tumor could occur on urethral remnant after radical cystectomy with urethrectomy for urothelial cancer. Inspection of the penis and urethral meatus is important during regular follow-up of patients after radical cystectomy.
Collapse
Affiliation(s)
- Koji Miki
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Kazutoshi Fujita
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Ken Kuwahara
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Shogo Adomi
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Takafumi Minami
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Masahiro Nozawa
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Kazuhiro Yoshimura
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Misa Kojima
- Department of PathologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Osamu Maenishi
- Department of PathologyKindai University Faculty of MedicineOsakasayamaJapan
| | - Hirotsugu Uemura
- Department of UrologyKindai University Faculty of MedicineOsakasayamaJapan
| |
Collapse
|
3
|
Murata Y, Shinojima T, Nakahira Y, Hamada M, Sasaki A, Asakura H. Recurrent urethral tumor with neuroendocrine differentiation in a female patient after radical cystectomy for bladder cancer. IJU Case Rep 2023; 6:199-202. [PMID: 37405032 PMCID: PMC10315247 DOI: 10.1002/iju5.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/18/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Urethral recurrence after radical cystectomy in female patients with bladder cancer is relatively uncommon. Recurrent bladder tumors with neuroendocrine differentiation are extremely rare. Case presentation A 71-year-old female patient who underwent radical cystectomy for bladder cancer presented with vaginal bleeding 19 months postoperatively. She was diagnosed with bladder cancer urethral recurrence. Urethral tumor en-bloc resection with the anterior vaginal wall was performed by combining abdominal and vaginal approaches. Pathological examination revealed a recurrent tumor of urothelial bladder cancer containing small-cell carcinoma components. Conclusion This case is the first report of a recurrent tumor with small-cell carcinoma in the female urethra after radical cystectomy for pure urothelial carcinoma.
Collapse
Affiliation(s)
- Yasuaki Murata
- Department of UrologySaitama Medical UniversityMoroyamaSaitamaJapan
| | | | - Yoko Nakahira
- Department of UrologySaitama Medical UniversityMoroyamaSaitamaJapan
| | - Mei Hamada
- Department of PathologySaitama Medical UniversityMoroyamaSaitamaJapan
| | - Atsushi Sasaki
- Department of PathologySaitama Medical UniversityMoroyamaSaitamaJapan
| | - Hirotaka Asakura
- Department of UrologySaitama Medical UniversityMoroyamaSaitamaJapan
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Sharbidre KG, Morani AC, Zahid M, Bhosale P, Lall C, Francis IR, Verma S. Imaging of neuroendocrine neoplasms of the male GU tract. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4042-4057. [PMID: 35412112 DOI: 10.1007/s00261-022-03510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 01/18/2023]
Abstract
Male genitourinary neuroendocrine neoplasms (GU-NENs) are rare, without any definite imaging characteristics. The WHO classified neuroendocrine neoplasms in the 2016 classification of the tumors of the urinary tract and genital organs along with other GU tumors; however, no pathologic grading system is available as published for gastroenteropancreatic neuroendocrine neoplasms. Often a multimodality approach using cross-sectional imaging techniques, such as molecular imaging and histopathology are implemented to arrive at the diagnosis. This article provides a review of the pathology and imaging features of the male GU-NENs.
Collapse
Affiliation(s)
- Kedar G Sharbidre
- Department of Radiology, University Of Alabama at Birmingham, Birmingham, USA.
| | - Ajaykumar C Morani
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mohd Zahid
- Department of Radiology, University Of Alabama at Birmingham, Birmingham, USA
| | - Priya Bhosale
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Chandana Lall
- Department of Radiology, University of Florida, Gainesville, USA
| | | | - Sadhna Verma
- Department of Radiology, University of Cincinnati, Cincinnati, USA
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Neuroendocrine Neoplasms of the Female Genitourinary Tract: A Comprehensive Overview. Cancers (Basel) 2022; 14:cancers14133218. [PMID: 35804996 PMCID: PMC9264819 DOI: 10.3390/cancers14133218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Primary neuroendocrine neoplasms (NENs) are a rare, heterogeneous group of tumors that include well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinoma, and paraganglioma. NENs in the urinary tract are observed in <0.05% of individuals, in whom the bladder is the most common site. In this review, we described the epidemiology, pathogenesis, imaging, staging, and management of the genitourinary NENs. Abstract Primary neuroendocrine neoplasms are a rare heterogeneous group of tumors that include well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinoma, and paraganglioma. An extensive literature search was used to compile the data regarding epidemiology, pathogenesis, imaging features, and management of the urinary system NENs. We also included the updated staging of the NENs at various locations of the urinary system.
Collapse
|
8
|
Shanks JH, Srigley JR, Brimo F, Comperat E, Delahunt B, Koch M, Lopez‐Beltran A, Reuter VE, Samaratunga H, Tsuzuki T, Kwast T, Varma M, Grignon D. Dataset for reporting of carcinoma of the urethra (in urethrectomy specimens): recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2019; 75:453-467. [DOI: 10.1111/his.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jonathan H Shanks
- Department of Histopathology The Christie NHS Foundation Trust Manchester UK
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto ON Canada
| | - Fadi Brimo
- McGill University Health Center Montréal QC Canada
| | - Eva Comperat
- Department of Pathology Hospital Tenon, HUEP, Sorbonne University Paris France
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences University of Otago Wellington New Zealand
| | - Michael Koch
- Department of Urology Indiana University School of Medicine Indianapolis IN USA
| | | | - Victor E Reuter
- Department of Pathology Memorial Sloan Kettering Cancer Center New York NY USA
| | - Hemamali Samaratunga
- Aquesta Specialized Uropathology Brisbane Qld, Australia
- Centre for Clinical Research The University of Queensland Brisbane Qld, Australia
- Princess Alexandra Hospital Brisbane Qld Australia
| | | | - Theo Kwast
- Laboratory Medicine Program University Health Network, University of Toronto Toronto ON Canada
| | - Murali Varma
- Department of Cellular Pathology University Hospital of Wales Cardiff UK
| | - David Grignon
- IUH Pathology Laboratory, Department of Pathology and Laboratory Medicine Indiana University School of Medicine Indianapolis IN USA
| |
Collapse
|
9
|
Abstract
BACKGROUND Primary small cell neuroendocrine carcinoma of the urinary tract is a very rare cancer, accounting for fewer than 0.5% of urinary tract tumors. These are aggressive neoplasms with high rates of metastases. Urethral diverticula can be found in up to 6% of women. CASE A 31-year-old woman presented with a clear vaginal discharge and an anterior vaginal wall mass that was thought to be a recurrent cyst. After surgical dissection, she was noted to have a urethral diverticulum with a solid nodule at the base. Final pathology showed a high-grade small cell neuroendocrine carcinoma. CONCLUSION Malignancy in a urethral diverticulum can occur in young patients. Clinicians should be aware of this possibility when choosing to manage urethral lesions expectantly.
Collapse
|
10
|
A Periurethral Mass in a Female Patient With Sarcoidosis. Urology 2017; 114:18-23. [PMID: 29122626 DOI: 10.1016/j.urology.2017.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
|
11
|
Facio FN, Spessoto LC, Ferraz de Arruda GJ, Arruda JF, Ferraz de Arruda JG, Facio MFW. Primary Mixed Glandular-endocrine Tumor of the Male Proximal Urethra: A Case Report. Urol Case Rep 2016; 6:1-3. [PMID: 27169014 PMCID: PMC4855907 DOI: 10.1016/j.eucr.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 12/16/2015] [Indexed: 11/16/2022] Open
Abstract
Primary urethral carcinoma is much more common in women than in men due to its association with urethritis. A 65-year-old man presented with a 10-month history of penile induration, obstructive voiding symptoms and hematuria. Urethrocystoscopy showed a solitary mass in the proximal urethra and no bladder involvement. It was performed penectomy without bladder neck excision and regional staging lymphadenectomy of the obturator lymph nodes. Pathological diagnosis revealed adenosquamous cell carcinoma with squamous and glandular components. We described a case of primary mixed glandular-endocrine tumor of the male proximal urethra consisting of adenosquamous cell carcinoma with squamous and neuroendocrine components.
Collapse
|
12
|
Heller DS. Lesions of the Female Urethra: A Review. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Debra S. Heller
- Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
| |
Collapse
|
13
|
Kanagarajah P, Ayyathurai R, Saleem U, Manoharan M. Small cell carcinoma arising from the bulbar urethra: a case report and literature review. Urol Int 2011; 88:477-9. [PMID: 22041867 DOI: 10.1159/000332154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/19/2011] [Indexed: 11/19/2022]
Abstract
Primary neuroendocrine carcinomas of the genitourinary tract are rare and aggressive tumors carrying a bad prognosis. With squamous cell and transitional cell carcinoma being the most commonly reported urethral malignancies, primary small cell carcinoma (SCC) of the urethra is extremely rare. To date, only 5 cases have been reported in the literature. We present the first case of primary SCC occurring in the bulbar urethra in an 89-year-old male. We discuss the clinical, histological and immunohistochemical features of SCC of the urethra. Furthermore, we summarize the available literature and discuss the possible treatment options for this rare yet aggressive neoplasm.
Collapse
Affiliation(s)
- Prashanth Kanagarajah
- Department of Urology, University of Miami-Miller School of Medicine, Miami, Fla., USA.
| | | | | | | |
Collapse
|