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Human Pathology Feb 2018Primary carcinomas of the urethra are rare and poorly understood lesions; hence, their clinical and pathologic spectrum is not completely defined. We analyzed a series...
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.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma in Situ; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Papillomaviridae; Papillomavirus Infections; Urethra; Urethral Neoplasms; Urothelium
PubMed: 28827100
DOI: 10.1016/j.humpath.2017.08.006 -
Molecular and Clinical Oncology Oct 2022Primary urethral carcinoma (PUC) has rarely been reported, notably with variant histology. The present case reports a 68-year-old male patient with a 3-month history of...
Primary urethral carcinoma (PUC) has rarely been reported, notably with variant histology. The present case reports a 68-year-old male patient with a 3-month history of difficulty voiding urine accompanied by a burning sensation in the urinary tract and hematuria. Urethrography and computed tomography (CT) indicated a mass localized in the urethral bulb. A fine needle biopsy revealed the mass to be a malignant tumor of the urethra. Partial penectomy was eventually performed and postoperative histopathological examination confirmed that the lesion was PUC, with mixed characteristics of urothelial and squamous differentiation. The patient was postoperatively followed up and at 9 months, a repeat CT scan revealed local recurrence and metastases. The patient rejected further treatment and eventually succumbed to the disease three months later. The present case report demonstrates an example in which urothelial and squamous differentiation simultaneously exist in the pathological report. The clinical features, diagnosis and treatment status of PUC were also summarized and analyzed to improve the clinical understanding of this unique disease.
PubMed: 36157318
DOI: 10.3892/mco.2022.2575 -
Urology Case Reports Jul 2020There are three major recognized histological types for primary urethral carcinoma (PUC). These include transitional cell carcinoma (55%), squamous cell carcinoma...
There are three major recognized histological types for primary urethral carcinoma (PUC). These include transitional cell carcinoma (55%), squamous cell carcinoma (21.5%), and adenocarcinoma (16.4%). However, primary urethral carcinoma still only accounts for approximately less than 1% of all bladder cancers. Current management includes surgery alone or surgery with adjunctive radiotherapy and chemotherapy. Current research suggests that in those cases managed with only surgery, the five-year disease-free survival is only 20-30%; as additional treatment with radiotherapy and chemotherapy is new recommendation, there is no published statistical data to suggest outcomes, only current clinical observation.
PubMed: 32309144
DOI: 10.1016/j.eucr.2020.101169 -
African Journal of Paediatric Surgery :... 2021Polyps of the urethra is a rare cause of obstruction of the lower urinary tract. The clinical presentation is not specific; the symptoms vary and may be isolated or...
BACKGROUND
Polyps of the urethra is a rare cause of obstruction of the lower urinary tract. The clinical presentation is not specific; the symptoms vary and may be isolated or associated, including acute retention of urine, dysuria, and hematuria. Ultrasound and voiding urethrocystography guide the diagnosis. Urethrocystoscopy confirms the diagnosis and allow the treatment. Our aim is to bring to light this rare condition and report our experience in the management of posterior urethral polyps.
SUBJECT AND METHODS
A retrospective study of posterior urethral polyp presented from 2008 to 2019 was performed. Charts were evaluated for clinical presentation, management, pathology findings, and long term follow-up.
RESULTS
Six patients were recorded. Dysuria and hematuria are the most reported features. Ultrasonography and voiding cystourethrogram made the diagnosis in 4 patients out of 6. Urethrocystoscopy made the diagnosis and transurethral resection in all our patients.
CONCLUSIONS
Posterior urethral polyp is a rare benign tumor in children. Urethrocystscopy allow both diagnostic and therapeutic.
Topics: Child; Cystoscopy; Humans; Male; Polyps; Retrospective Studies; Urethra; Urethral Neoplasms
PubMed: 34341198
DOI: 10.4103/ajps.AJPS_88_20 -
International Journal of Surgery Case... Aug 2021Primary tumors of the female urethra are exceedingly rare and account for <0.02% of the malignant disease occurring in women. This disease usually presents late and,...
INTRODUCTION
Primary tumors of the female urethra are exceedingly rare and account for <0.02% of the malignant disease occurring in women. This disease usually presents late and, hence, has a poor outcome. Early diagnosis is necessary to prevent further metastasis and prevent urinary catheter-dependant. Tumors arising from the distal urethra tend to be early stage and cure rates are high, however lack of knowledge about this disease is notorious, the transmission of knowledge is made only by case reports.
CASE PRESENTATION
A 76-years-old woman presented with the chief complaint of lower pelvic pain. The complaintas also accompanied by a burning sensation in the urethra and stranguria, urinary retention, and hematuria. Macroscopic observation revealed the lesion was whitish with vegetative aspect at the urethral meatus, involving the entire urethra. The fragile mass was palpable in distal urethra and external meatus urethra per vaginally and easily bleedings. Laboratory examination of blood chemistry results within normal limit. Urinalysis showed pyuria and hematuria. Urethrocystoscopy findings were whitish lesion with vegetative aspect also fragile mass along the urethra, abnormal bladder neck, and bladder mucous was hyperemis. The histopathological result showed metaplasia squamous cell carcinoma, clear cell carcinoma. She is planned on getting cystouretherectomy (anterior exenteration) later.
CLINICAL DISCUSSION
The female urethral carcinoma is a disease with low prevalence with urothelial carcinoma (transitional cell) is the most common histological type (Leão et al., 2016; Adolfsson et al., 2012). Symptoms of urethral carcinoma are varied. The carcinoma spreads initially by local invasion into the periurethral tissue, vagina, and vulva and proximally spread to the bladder neck (Leão et al., 2016; Mittal et al., 2020). Distant metastasis is uncommon (Mittal et al., 2020). The most suitable method for collecting material for biopsy is the urethrocystoscopy. MRI is commonly used for staging. For post-surgical staging, the best investigation is the excretory urography (Gourtsoyianni et al., 2011; Picozzi et al., 2012). The management in vogue are surgical such as tumor excision, radical nephro-ureterectomy or anterior pelvic exenteration with radiotherapy or chemotherapy complementary. This cancer is associated with poor outcomes. Therefore, prognostic factors are important to be known.
CONCLUSION
Although female urethral carcinoma is a rare disease entity, clinicians should have strong suspicion of malignancies in patients to make an exact diagnosis. Early radical surgery can achieve better outcomes, although the standard therapy remains controversial.
PubMed: 34311342
DOI: 10.1016/j.ijscr.2021.106100 -
Taiwanese Journal of Obstetrics &... Sep 2021We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer. (Review)
Review
OBJECTIVE
We report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer.
CASE REPORT
A 68-year-old woman presented with a non-healing urethral ulcer accompanied with vulvar pruritus, which failed to medical treatment. Her medical history was unremarkable, lacking fever, weight loss or unexplained fatigue. There were no enlarged lymph nodes or palpable liver or spleen upon physical examination. Pelvic examination revealed an ulcerative lesion arising from the posterior wall of the urethral meatus. Cystourethroscopy showed no bladder involvement. Surgical excision of the urethral ulcer was done and immunohistochemical report showed a diffuse large B-cell lymphoma. Bone marrow needle biopsy and computed tomography were done and the diagnosis of primary diffuse large B-cell urethral lymphoma stage IEA was made. She underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab and was free of disease for 51 months.
CONCLUSION
This report of urethral lymphoma was presented as a non-healing ulcer initially, which was totally different previous reports, presenting with bleeding, either vaginal or urinary, urinary frequency, dysuria, urine retention and self-perceived mass, suggesting that unhealed ulcer on the perineal area should be promptly evaluated and avoidance of unnecessary delayed therapy for possible curable disease.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Biopsy; Cyclophosphamide; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Ulcer; Urethra; Urethral Neoplasms; Vincristine
PubMed: 34507675
DOI: 10.1016/j.tjog.2021.07.025 -
Modern Pathology : An Official Journal... Jan 2018Primary mucinous tumors and secondary tumors involving the prostate gland are relatively uncommon, however they have important diagnostic, therapeutic, and prognostic... (Review)
Review
Primary mucinous tumors and secondary tumors involving the prostate gland are relatively uncommon, however they have important diagnostic, therapeutic, and prognostic implications. The primary mucinous tumors of the prostate include mucinous (colloid) adenocarcinoma of the prostate, prostatic adenocarcinoma with mucinous features, and mucinous adenocarcinoma of the prostatic urethra (mucin-producing urothelial-type adenocarcinoma of the prostate). Mucinous adenocarcinoma of the prostate is defined as a primary prostatic acinar tumor characterized by the presence of at least 25% of the tumor composed of glands with extraluminal mucin. This diagnosis can only be made in radical prostatectomy specimens. Recent studies have shown that these tumors have a similar or in some cases better prognosis than conventional prostatic adenocarcinoma treated by radical prostatectomy. The preferred terminology for tumors that are composed of <25% extraluminal mucinous component in radical prostatectomy specimens is 'prostatic adenocarcinoma with mucinous features.' All cases of prostatic adenocarcinoma with extraluminal mucinous components in prostate needle core biopsies or transurethral resection of the prostate specimens are also referred to as 'prostatic adenocarcinoma with mucinous features.' Mucinous adenocarcinoma of the prostatic urethra (mucin-producing urothelial-type adenocarcinoma of the prostate) as the name implies, does not arise from prostatic acini or ducts, and is a distinct entity that arises from the prostatic urethra usually from urethritis glandularis or glandular metaplasia with malignant transformation, and is analogous to adenocarcinoma with mucinous differentiation arising from the urinary bladder. This tumor is aggressive and has a relatively poor prognosis. The most common secondary tumors that arise from adjacent organs and spread (direct extension or metastasis) to the prostate gland, include urothelial carcinoma of the bladder and colorectal adenocarcinoma. Other secondary tumors that may involve the prostate include metastatic epithelial tumors from several other sites, malignant melanoma and soft tissue tumors.
Topics: Adenocarcinoma, Mucinous; Adolescent; Adult; Aged; Aged, 80 and over; Biopsy, Large-Core Needle; Colorectal Neoplasms; Diagnosis, Differential; Humans; Male; Middle Aged; Neoplasm Grading; Prostate; Prostatectomy; Prostatic Neoplasms; Terminology as Topic; Urethral Neoplasms; Urinary Bladder Neoplasms; Young Adult
PubMed: 29297488
DOI: 10.1038/modpathol.2017.132 -
Asian Journal of Urology Oct 2022Primary urethral carcinoma (PUC) is a rare malignant carcinoma but with limited therapeutic options. This review aims to provide an overview of the current strategies on... (Review)
Review
OBJECTIVE
Primary urethral carcinoma (PUC) is a rare malignant carcinoma but with limited therapeutic options. This review aims to provide an overview of the current strategies on this patient settings.
METHODS
Recent literature ranging from January 1987 and December 2021 was assessed through PubMed search to assess the diagnostic and therapeutic principles of PUC.
RESULTS
A complete of examination including cystoscopy, imaging, and biopsy should be conducted for these patients. Once diagnosed, the clinical decision of PUC should be made according to the tumor location, pathological pattern, and extent of the tumor. For patients with superficial and distal urethral lesions, organ sparing approaches or radical reconstructive procedures can be utilized. While for more advanced disease or nodal involvement, an optimal multimodal treatment strategy consisted of surgery and radiochemotherapy should be adopted. For patients with urothelial carcinoma of the prostate, the management including transurethral resection of the prostate followed by bacille Calmette-Guerin or radical cystoprostatectomy should depend on the infiltration depth of PUC.
CONCLUSION
A complete of examination is important for the diagnosis of PUC. The management of PUC should be determined by the location, pathological pattern, and extent of the tumor. More multi-institutional collaborations should be held to investigate better treatment modalities for PUC.
PubMed: 36381601
DOI: 10.1016/j.ajur.2022.04.005 -
BMJ Open Dec 2022We constructed Bladder Cancer Data Base Sweden (BladderBaSe) 2.0 to expand studies in BladderBaSe on incidence, treatment outcomes, side effects, survival and health...
PURPOSE
We constructed Bladder Cancer Data Base Sweden (BladderBaSe) 2.0 to expand studies in BladderBaSe on incidence, treatment outcomes, side effects, survival and health economic aspects of men and women with cancer in the urinary bladder, upper tract urothelial carcinoma (UTUC) (renal pelvis and ureter) and urethral carcinoma.
PARTICIPANTS
BladderBaSe 2.0 includes 53 298 patients with cancer in the urinary bladder, diagnosed from 1 January 1997 to 31 December 2019, and 961 patients with UTUC in the renal pelvis and 792 in the ureter, and 146 patients with urethral urothelial carcinoma, diagnosed from 1 January 2015 to 31 December 2019, and in total 275 816 participants in reference groups, free of cancer in the urinary tract, matched 1:5 on sex, age and county.
FINDINGS TO DATE
To date, 18 published studies based on data from the BladderBaSe have investigated calendar time trends in survival; impact of gender, socioeconomic factors, tumour aggressiveness and hospital volume for radical cystectomy on prognosis; survival after radical cystectomy compared with radical radiotherapy; risk factors for complications and side effects after radical cystectomy such as thromboembolism, strictures of ureteroenterostomies and incisional hernia.
FUTURE PLANS
The BladderBaSe initiators are currently investigating gender-dependent detection delays due to urinary tract infections; survival after non-muscle invasive bladder cancer with respect to the number of transurethral resections; short-term outcomes comparing open and robot-assisted radical cystectomy; studies on risk for intravesical recurrence after different diagnostic measures in UTUC, and suicide risk after bladder cancer diagnosis. The BladderBaSe project group is open for collaborations with national and international colleagues.
Topics: Male; Humans; Female; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Sweden; Prognosis; Treatment Outcome; Cystectomy; Retrospective Studies
PubMed: 36600418
DOI: 10.1136/bmjopen-2022-064898 -
BJU International Sep 2020To evaluate treatment patterns and associated outcomes of patients with urethral cancer.
OBJECTIVES
To evaluate treatment patterns and associated outcomes of patients with urethral cancer.
PATIENTS AND METHODS
After obtaining institutional review board approval we identified 165 patients treated for primary urethral cancer between 1956 and 2017. Treatment included monotherapy (surgery or radiation), dual therapy (surgery+radiation, surgery+chemotherapy, or chemotherapy+radiation) or triple therapy (surgery+radiation+chemotherapy). Rates of different treatments were described by treatment year. The association between treatment type and outcomes was evaluated with multivariable Cox regression models, adjusting for disease characteristics.
RESULTS
The study cohort included 74 men and 91 women, with a median age of 61 years. Common histologies were squamous cell (36%), urothelial (27%) and adenocarcinoma (25%). At presentation, 72% of patients had invasive disease, 24% had nodal involvement, and 5% had metastases. Treatment included monotherapy (57%), dual therapy (21%), and triple therapy (10%). The use of monotherapy decreased over time, while rates of dual therapy remained consistent, and rates of triple therapy increased. The median follow-up was 4.7 years. Estimated 5-year local recurrence-free, disease-specific and overall survival were 51%, 48% and 41%, respectively. Monotherapy was associated with decreased local recurrence-free survival after adjusting for stage, histology, sex and year of treatment (P = 0.017). There was no evidence that treatment type was associated with distant recurrence, cancer-specific or overall survival.
CONCLUSIONS
We found preliminary evidence that multimodal therapy, more commonly used in recent years, was of benefit in patients with primary urethral cancer. This finding should be confirmed in further studies involving multiple centres because of the low incidence of the disease.
Topics: Adult; Aged; Cohort Studies; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Urethral Neoplasms
PubMed: 32336001
DOI: 10.1111/bju.15095