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Urethral AdenoCa

Urethral AdenoCa

57 y/o female presents with hematuria. Cross-sectional imaging demonstrates a 5cm urethral mass extending from bladder neck to meatus (MRI cut shown), no nodes, no mets. Chest imaging negative. Cystoscopy and pelvic exam confirm a firm urethral mass. Transurethral bx  =  high-grade adeno ca. 


What's next? Anterior exent vs radical urethrectomy/bladder neck closure/catheterizable channel?  Thoughts? 




This is rare, but here's some background:



¨Female Urethra

¤     Proximal 1/3 transitional epithelium

¤     Distal 2/3 stratified squamous

¨

 

Adenocarcinoma

¤    From Proximal 1/3

¤   

    Clear cell (less common) vs non-clear cell

¤    

    Initially thought to arise from paraurethral Skene glands, the female homologue of prostate, since tumors stain for PSA and
       PAS – latest data is conflicting

¤   

    In one series (n=6), no tumor stained for PSA, but all stained for CA-125, suggesting mullerian origin

¤    

    No treatment consensus exists

¤     

      May be more aggressive than squamous or TCC

¤    

    In a large series (n=44) of female urethral cancers, no pts with adeno (n=13) were alive at 5 years (and only 10% of pts with 
      tumors >4cm), irrespective of tx modality

    ¤

    Mayo series  from 1948 to 1999 (total n=55, adeno n=14) :

n         Higher recurrence for local excision (n=26) vs radical urethrectomy or anterior exenteration

n         Neither adjuvant XRT nor chemo appear to improve rates of systemic recurrence nor survival

n         Adjuvant XRT may decrease rates of systemic recurrence

 

Good Ref:  Miller J, Karnes R  Clin. Genitourinary Cancer  2008, 6, 131

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