Single‐institution experience with primary tumours of the male urethra

Gillitzer, R.; Hampel, Christian; Wiesner, Christoph; Hadaschik, Boris; Thüroff, Joachim W.

doi:10.1111/j.1464-410x.2007.07347.x

Cited by 23 publications

(7 citation statements)

References 15 publications

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“…7 Urine in the diverticulum led to symptoms, such as infection, stone formation and even carcinoma. 1,5,8 Although UC is the predominant subtype of primary UC (54%-65%), histologically, the most common subtype of UDC is adenocarcinoma, followed by SCC and UC in females. 1,3,5 In the literature, 10 females and 1 male SCC of urethral diverticulum have been reported (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Ekin¹,

Yıldırım²,

Bayol³

et al. 2015

CUAJ

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Primary urethral carcinomas are uncommon, with urothelial carcinoma as the most common subtype. Urethral diverticulum is also rarely seen in men. A 44-year-old male presented with voiding symptoms. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. A pathological examination revealed a well-differentiated squamous cell carcinoma (SCC) located inside an urethral diverticulum. We report this unusual case because primary SCC of the male urethral diverticulum is extremely rare. To our knowledge, our patient is only the second reported case. IntroductionPrimary urethral carcinoma (UC) is rare and accounts for less than 1% of all cancers.1,2 UC is the most common subtype. Generally, UCs are seen in the 5th decade.1,2 Patients presented with non-specific and overlapping clinical signs and symptoms.1,3 Management of UC is still controversial and challenging due to lack of experience.3 The surgical approach depends on the location and extent of the tumour. In advanced urethral squamous cell carcinoma (SCC), a combination of surgery, radiotherapy, and chemotherapy is recommended.3-6 The 5-year overall survival in patients with UC is about 50% to 55%. 2,3,5 Case reportA 44-year-old male presented with voiding difficulty and constipation for 3 months. He had a history of right nephrectomy for non-functional kidney secondary to a kidney stone. Although digital rectal examination revealed a hard, fixed mass on the anterior rectal wall, his prostate-specific antigen level was 0.61 ng/mL. A transrectal prostate biopsy was performed, and the pathological examination revealed a welldifferentiated SCC. The patient was referred to our urology clinic with a preliminary diagnosis of primary SCC of the prostate. A magnetic resonance imaging (MRI) showed a 6 × 7.2 × 8.1-cm round mass with smooth margins and heterogeneous internal enhancement. The mass abutted the rectum and bladder, and extended to the apex of the prostate and the levator ani without sign of invasion (Fig. 1). The prostate and lymph nodes were normal. For the purpose of a differential diagnosis, a colonoscopy was performed and the mucosa was normal. The patient underwent a cystourethroscopy and biopsy under anesthesia. We demonstrated a large wide-mouthed urethral diverticulum and tumour growth in the bulbomembranous urethral diverticulum. The prostate was normal and the dimensions of the prostate were compatible with the patient's age. The bladder mucosa was intact, with external tumour compression. A histopathologic examination revealed a well-differentiated SCC with an inverted and warty growth pattern, keratinization with keratin pearl and dyskeratotic cells.The patient was informed about the radical cystoprostatectomy and abdominoperineal resection if organ preservation was unfavourable, and informed consent was obtained. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. On gross examination of the excision specimen, there was the pr...

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Section: Discussionmentioning

confidence: 99%

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Ekin¹,

Yıldırım²,

Bayol³

et al. 2015

CUAJ

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“…2,5 Bulbar urethral disease carries a worse prognosis than distal disease. 2,6,7 Results from treatment with surgery alone for bulbar SCC have been disappointing, with 5-year diseasefree survival of 0% to 15%, 1,6 because of its tendency for presentation at an advanced local and distal stage. More recently, combined treatment with chemoradiotherapy and surgery was suggested to improve local control and survival 8,9 ; however, the optimal treatment strategy is not known.…”

Section: Discussionmentioning

confidence: 99%

Squamous Cell Carcinoma of the Bulbar Urethra

Memon

Lynch

Cleeve

et al. 2011

JCO

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A 49-year-old man with a history of balanitis xerotica obliterans and meatal stricture treated with circumcision and meatoplasty 4 years before presented with a recurrent urinary tract infection. Urethroscopy revealed a lesion in the bulbar urethra, which was confirmed to be a squamous cell carcinoma (SCC) with histology. Magnetic resonance imaging (MRI) confirmed a bulky tumor that emanated from the bulb of the penis, abutted the anorectal junction, and extended to involve the corpora cavernosa, the urogenital diaphragm, the apex of the prostate, and the levator ani. [ 18 F]fluorodeoxyglucose positron emission tomography (PET) showed an avid primary lesion with biliateral inguinal lymph node avidity. The multidisciplinary consensus was treatment with radical chemoradiotherapy to obtain local control and treat potential micrometastatic disease followed by radical surgery with curative intent and to gain local control if restaging imaging showed no metastatic disease. The patient received six cycles of cisplatin and 60 Gy of radiotherapy in 30 fractions over 38 days. Restaging MRI 6 weeks after completion of chemoradiotherapy showed a decrease in size of the tumor with central necrosis and a new lesion in the distal penis. PET showed a partial metabolic response in the primary tumor (Figs 1A, PET at diagnosis and 1B, 6 weeks after chemoradiotherapy), persisting mild uptake in a single inguinal node, and new mild uptake in an external iliac node, which was thought to be reactive and was subsequently confirmed by using fine-needle aspiration. Because of the good response to chemoradiotherapy, the consensus was to repeat imaging in 6 weeks to assess a possible ongoing response to chemoradiotherapy before radical surgery. Six weeks later, PET showed interval progression (Figs 2A, PET 6 weeks after chemoradiotherapy and 2B, 12 weeks after chemoradiotherapy), with more intense uptake in the primary tumor, that

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“…Symptoms are non-specific2 3 and unaware to patients and so presentation is usually delayed 2. Because of difficulty in achieving local control,1 proximal urethral cancer carries a worse prognosis than distal 4 5. However, cases of a curative response to chemo-radiotherapy alone have been reported6 7 but radical cystoprostectomy, pelvic lymphadenectomy and total penectomy is a standard treatment option for proximal urethral cancers 1…”

Section: Descriptionmentioning

confidence: 99%

Urethral tumour: rare images of unaware entity

et al. 2013

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DESCRIPTIONA 55-year man with a history of thin stream of urine and dysuria for the last 7 years presented with mild haematuria followed by acute urinary retention for 2 days. Clinical examination showed indurated mass with urethrocutaneous fistula in perineum ( figure 1A). Per-urethral catheter could not be negotiated and so urine was drained by suprapubic catheterisation. Retrograde urethrogram and voiding cystourethrogram were suggestive of filling defect in bulbar urethra (figure 1B,C). Urethroscopy (figure 2A) revealed a broad base lesion arising from dorsal and left lateral wall of distal bulbar urethra occluding the lumen of urethra. MRI showed a low signal intensity heterogeneous mass of bulbo-membranous urethra that invaded into spongiosa and penile skin with bilateral inguinal node involvement (figure 2B). Biopsy was suggestive of transitional cell carcinoma (figure 3). The patient was counselled for cystoprostectomy with total penectomy but he refused. He received 60 Gy of radiotherapy in 30 fractions followed by six cycles of methotrexate, vinblastine, doxorubicin and cisplatin. Follow-up at 3 months showed good local response and absence of progression in regional nodes. Urethral carcinoma is very rare and is less common in men than in women.

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Single‐institution experience with primary tumours of the male urethra

Cited by 23 publications

References 15 publications

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature

Squamous Cell Carcinoma of the Bulbar Urethra

Urethral tumour: rare images of unaware entity

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