Urethral adenocarcinoma with bilateral iliac and inguinal lymph nodes which revelead by urethra ectropion in 67-year-old woman: A case report

Abstract

We reported a case of urethral adenocarcinoma in a 67-year-old woman who was admitted for difficulty voiding, irritative voiding symptoms, bloody urethral discharge and urinary incontinence. Physical examination was realised by gyneacologist and conclued to urological pathology. Urological examination was showed urethral ectropion which was bleeding. She had no fewer, no pelvic pain even less loss weight. Her general state was satisfactory. The lymph nodes of right side inguinal were felt. Computed imaging was showed involvement of right side bladder and bilateral iliac inguinal lymph nodes. Urethral ectropion biopsy anatomopathological screening was conclued to clear cell adenocarcinoma but CIS lesions were not found. The tumor staging was T3N2M0. A radiotherapy was perfomed. The patient was improvement of voiding symptoms and decrease lymph nodes size. Primary urethral carcinomas are rare pathology especially in the woman. Several histological types exist. However, chemotherapy and radiotherapy are very effective on very advanced stages. This cancer may be revealed by an urethral ectropion in a year-old woman.

Keywords

Ectropion / Urethra / Adenocarcinoma / Radiotherapy

CONFLICTS OF INTEREST DISCLOSURE

No conflicts of interest.

References

[1] Dalbagni G, Zhang ZF, Lacombe L, et al. Female urethral carcinoma: an analysis of treatment outcome and a plea for a standardized management strategy. Br J Urol. 1998; 82: 835. https://doi.org/10.1046/j.1464-410X.1998.00878.x

[2] Dalbagni G, Zhang ZF, Lacombe L, et al. Male urethral carcinoma: analysis of treatment outcome. Urology. 1999; 53: 1126. https://doi.org/10.1016/S0090-4295(98)00659-1

[3] Traboulsi SL, Witjes JA, Kassouf W. Contemporary management of Primary Distal Urethral Cancer. Urol Clin N Am. 2016; 43: 493-503. PMid:27717435. https://doi.org/10.1016/j.ucl.2016.06.010

[4] Kamran ZS, Sexton WJ, Poch MA. Management of urethral recurrences urothelial and nonurothelial. Urol Clin N Am. 2016; 43: 515-52. PMid:27717437.

[5] Zinman LN, Vanni AJ. Management of proximal primary urethral cancer should multidisciplinary therapy Be the Gold Standard? Urol Clin N Am. 2016; 43: 505-513. PMid:27717436.

[6] Gatta G, van der Zwan JM, Casali PG, et al. Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer. 2011; 47: 2493-511. PMid:22033323. https://doi.org/10.1016/j.ejca.2011.08.008

[7] Swartz MA, Porter MP, Lin DW, et al. Incidence of primary urethral carcinoma in the United States. Urology. 2006; 68: 1164-8. PMid:17141838. https://doi.org/10.1016/j.urology.2006.08.1057

[8] Medina Perez M, Valero Puerta J, Sanchez Gonzalez M, et al. Squamous carcinoma of the male urethra, its presentation as a scrotal abscess. Arch Esp Urol. 1999; 52: 792-4 [in Spanish].

[9] Wiener JS, Liu ET, Walther PJ. Oncogenic human papillomavirus type 16 is associated with squamous cell cancer of the male urethra. Cancer Res. 1992; 52: 5018-23.

[10] Ahmed K, Dasgupta R, Vats A, et al. Urethral diverticular carcinoma: an overview of current trends in diagnosis and management. Int Urol Nephrol. 2010; 42: 331-41. PMid:19649767. https://doi.org/10.1007/s11255-009-9618-x

[11] Libby B, Chao D, Schneider BF. Non-surgical treatment of primary female urethral cancer. Rare Tumors. 2010; 2: e55.

[12] Derksen JW, Visser O, de la Riviere GB, et al. Primary urethral carcinoma in females: an epidemiologic study on demographical factors, histological types, tumour stage and survival. World J Urol. 2013; 31: 147-53. PMid:22614443. https://doi.org/10.1007/s00345-012-0882-5

[13] Carroll PR, Dixon CM. Surgical anatomy of the male and female urethra. Urol Clin North Am. 1992; 19: 339-46.

[14] Gourtsoyianni S, Hudolin T, Sala E, et al. MRI at the completion of chemoradiotherapy can accurately evaluate the extent of disease in women with advanced urethral carcinoma undergoing anterior pelvic exenteration. Clin Radiol. 2011; 66: 1072-8. PMid:21839430. https://doi.org/10.1016/j.crad.2011.07.039

[15] Gakis G, Morgan TM, Efstathiou JA, et al. Prognostic factors and outcomes in primary urethral cancer: results from the international collaboration on primary urethral carcinoma. World J Urol. 2016; 34: 97-103. PMid:25981402. https://doi.org/10.1007/s00345-015-1583-7

[16] Rabbani F. Prognostic factors in male urethral cancer. Cancer. 2011; 117: 2426-34. PMid:24048790. https://doi.org/10.1002/cncr.25787

[17] Dimarco DS, Dimarco CS, Zincke H, et al. Surgical treatment for local control of female urethral carcinoma. Urol Oncol. 2004; 22: 404-9. https://doi.org/10.1016/S1078-1439(03)00174-1

[18] Bracken RB, Johnson DE, Miller LS, et al. Primary carcinoma of the female urethra. J Urol. 1976; 116: 188. https://doi.org/10.1016/S0022-5347(17)58741-8

[19] Narayan P, Konety B. Surgical treatment of female urethral carcinoma. Urol Clin North Am. 1992; 19: 373.

[20] Koontz BF, Lee WR. Carcinoma of the urethra: radiation oncology. Urol Clin North Am. 2010; 37: 459. PMid:20674700. https://doi.org/10.1016/j.ucl.2010.04.007

[21] Johnson DE, O’Connell JR. Primary carcinoma of female urethra. Urology. 1983; 21: 42. https://doi.org/10.1016/0090-4295(83)90120-6

[22] Moinuddin Ali M, Klein FA, Hazra TA. Primary female urethral carcinoma. A retrospective comparison of different treatment techniques. Cancer. 1988; 62: 54. https://doi.org/10.1002/1097-0142(19880701)62:1＜54::AID-CNCR2820620112＞3.0.CO;2-5

[23] Licht MR, Klein EA, Bukowski R, et al. Combination radiation and chemotherapy for the treatment of squamous cell carcinoma of the male and female urethra. J Urol. 1918; 153: 1995.