Management of primary adenocarcinoma of the female urethra: Report of two cases and review of the literature

Abstract

Primary adenocarcinoma of the female urethra is rare and only a few retrospective cases have been published. The origin of urethral adenocarcinomas remains unclear. Certain authors have suggested that urethral adenocarcinomas in females originate at the periurethral Skene's glands. We report one case of urethral adenocarcinoma of the proximal urethra in a 44-year-old female who presented with painless urethral bleeding. Abdominal and pelvic CT scan with contrast and chest radiology were unremarkable. Biopsy of the mass revealed adenocarcinoma of the urethra. The patient was treated with partial urethrectomy and was free of disease for more than 5 years. We also present another rare case of mucinous adenocarcinoma in a 52-year-old female who complained of an enlarged urethral mass. Pelvic MRI revealed a tumor surrounding the whole urethra and bilateral inguinal lymph nodes. A puncture biopsy later revealed that the tumor was mucinous adenocarcinoma. Anterior pelvic exenteration with pelvic and bilateral lymph node dissection was performed and chemotherapy was administered. The patient was followed up for 12 months and did not experience local recurrence or distant metastasis. In conclusion, for the diagnosis of urethral cancer, a biopsy is necessary for any suspicious urethral lesions. MRI is recommended for tumor staging. Small, superficial, distal urethral tumors may be treated with excision of the distal urethra. For advanced female urethral cancer, a combination of chemotherapy, radiation therapy and surgery is recommended for optimal local and distant disease control. Regular follow-up is required in these patients.

Figure 1

Transvaginal ultrasonography of urethra demonstrating a well-defined hyperechoic mass with approximate dimensions of 12x11x10 mm.

Figure 2

HE, x100. Adenocarcinoma of distal female urethra.

Figure 3

Pelvic MRI demonstrating lesion surrounding the urethra, (A) with slightly higher signal in T1- and T2-weighted images and (B) uneven enhancement after contrast administration. (C) Enlarged lymph nodes with even enhancement were observed in the bilateral inguinal region.

Figure 4

HE, x100 showing mucinous adenocarcinoma of urethra with invasion to the superficial muscular layer of the anterior vaginal wall.