Urethral metastasis from a sigmoid colon carcinoma: a quite rare case report and review of the literature

Abstract

Background: Urethral metastatic adenocarcinoma is extremely rare. Moreover, only 9 previous cases with metastases from colorectal cancer have been reported to date, and not much information on urethral metastases from colorectum is available so far.

Case presentation: We report our experience in the diagnosis and the management of the case with urethral metastasis from a sigmoid colon cancer. A 68-year-old man, who underwent laparoscopic sigmoidectomy for sigmoid colon carcinoma four years ago, presented gross hematuria with pain. Urethroscopy identified a papillo-nodular tumor 7 mm in diameter in the bulbar urethra. CT-scan imaging revealed the small mass of bulbous portion of urethra and solitary lung metastasis. Histological examination of the tumor obtained by transurethral resection showed moderately differentiated adenocarcinoma, which was diagnosed as a metastasis of a sigmoid colon carcinoma pathologically by morphological examination. Immunohistochemical analysis of the urethral tumor revealed the positive for cytokertin 20 and CDX2, whereas negative for cytokertin 7. These features were consistent with metastatic adenocarcinoma of the sigmoid colon cancer. As the management of this case with urethral and lung metastasis, 6-cycle of chemotherapy with fluorouracil with leucovorin plus oxaliplatin was administered to the patient, and these metastases were disappeared with no recurrence of disease for 34 months.

Conclusion: Urethral metastasis from colorectal cancer is a very rare occurrence. However, in the presence of urinary symptoms, the possibility of the urethral metastasis should be considered.

Figure 1

Urethral tumor detected four years after sigmoidectomy. (a) Cystoscopy demonstrated papillary tumor of approximate 7 mm in the urethral wall of the distal-potion from the urethral sphincter. (b) Cystoscopy demonstrated scar of the transurethral resection without recurrence of the tumor. (c) CT-scan imaging showed the small mass of bulbous portion of urethra (white arrow). (d) CT-scan imaging showed the total disappearance of urethral metastasis.

Figure 2

Urethral tumor showed moderately differentiated adenocarcinoma consistent with sigmoid colon cancer (original magnification, ×20).

Figure 3

Immunohistochemical staining of urethral tumor using an anticytokeratin antibody, (a) CK20 and (b) CK7 (original magnification, ×20), and using an antibody against the intestinal epithelia-specific nuclear transcription factor, (c) CDX2 (original magnification, ×20). The immunohistochemical phenotype showed CK20+/CK7-/CDX2 +.