Urethral diverticulum carcinoma in females—a case series and review of the English and Japanese literature

Abstract

The aims of our study were to describe our case series of three urethral diverticulum carcinomas (UDC) in women and to review the literature on UDC in females to determine patient characteristics, presenting symptoms and outcomes along with optimal investigations and treatment modalities. A literature search was performed utilizing Medline, EMBASE and the Cochrane library for all papers including case reports on UDC in women published to date. The results along with those of our three cases are detailed. A total of 126 cases of UDC in women have been reported; 75% adenocarcinoma (Adenoca), 15% transitional cell carcinoma (TCC) and 10% squamous cell carcinoma (SCC). Median age at presentation was 53 years (range, 14–81 years). The commonest presenting symptoms were bleeding and retention. Cystoscopy, MRI and trans-urethral biopsy were the commonest methods of diagnosis. Treatment was radiotherapy +/− chemotherapy alone in 21%, local excision +/− radiotherapy in 44%, urethrectomy in 3% and anterior exenteration +/− radiotherapy in 32%. At last follow-up 63% were alive and well, 10% were alive with recurrent cancer and 25% had died from their disease. UDC is rare in women. It is predominantly adenocarcinoma. There is no established treatment and survival is at best moderate. An international registry and consensus on management is needed if this is to be improved.

Sarcomatoid urothelial carcinoma arising in the female urethral diverticulum

“…Primary female urethral carcinomas are rare, and the most common histological subtype is urothelial carcinoma (45%), followed by adenocarcinoma (29%), squamous cell carcinoma (19%), and undifferentiated carcinoma (6%), according to a national urethral cancer survey conducted in the Netherlands [ 3 ]. UDC is very unusual, accounting for only 5% of all female urethral carcinomas [ 1 , 2 ]. More than 120 cases of UDC have been reported, and adenocarcinoma is the most common pathology (75%), while urothelial carcinoma (15%) and squamous cell carcinoma (10%) are less frequent [ 1 , 2 ].…”

“…Urethral diverticular carcinoma (UDC) is extremely rare; the most common histological subtype is adenocarcinoma [ 1 , 2 ]. Sarcomatoid urothelial carcinoma (UC) is also unusual.…”

Giant anterior urethra stones combined with a diverticulum: a case report

“…Excretory urography and urethroscopic surgery are the best choices for urethral diverticulum diagnosis. There are reports in the literature that there may be cancerous changes in the urethral diverticulum, especially in patients with diverticulum complicated with stones, 4 indicating that biopsy after diverticulectomy is essential.…”

Diagnostic tools for female urethral diverticulum: Current perspectives

“…A notable review of English and Japanese literature on the problem of urethral diverticulum carcinoma (UDC) in women, an extremely rare condition (only 126 reported cases) with several diagnostic difficulties because of its nonspecific presentation. 46 Urine cytology may be a useful initial screening test and has been reported to be positive in 10/11 (91%) cases in which it was utilised. The gold standard investigations to date seems to be a combination of gadolinium-enhanced MRI which can be used for diagnosis, staging and surveillance followed by transvaginal trucut or transurethral biopsies for definitive diagnosis.…”

“…Moreover, cystoscopy may play an important role in the pathological diagnosis and in localization of the tumor origin and CT may be used to assess for lymph node enlargement, distant tissue and bone metastasis. 46 Conclusions UD is still difficult to diagnose and certainly, the first essential step for a timely diagnosis is the idea of the possibility of a UD in women with persistent lower urinary tract symptoms. Clinicians should know the main imaging features of this pathology and also the multiple, currently available techniques for its correct diagnosis.…”