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Case Reports
. 2020 Nov:67:68-71.
doi: 10.1016/j.clinimag.2020.05.030. Epub 2020 May 30.

Isolated urethral metastasis from appendiceal mucinous adenocarcinoma

Pamela I Causa Andrieu  1 , Jennifer S Golia Pernicka  2 , Gabriela Faria E Silva Costa  3 , Gregory T Chesnut  4 , Jaspreet S Shandu  4 , Chen Ying-Bei  5 , Iva Petkovska  2
Affiliations
Case Reports

Isolated urethral metastasis from appendiceal mucinous adenocarcinoma

Pamela I Causa Andrieu et al. Clin Imaging. 2020 Nov.

Abstract

We are presenting a compelling case of a 61-year-old female with a history of appendiceal mucinous adenocarcinoma (AMA) with a new complaint of irritative lower urinary tract symptoms. Magnetic resonance imaging (MRI) showed a semi-circumferential, T2 hyperintense, rim enhancing, and lacking restricted diffusion lesion involving the urethra and infiltrating the right perineal and internal obturator muscles. The suspected differential diagnosis was urethral malignancy, based on her cancer history and MRI findings. After interdisciplinary consensus, the patient underwent excision of the lesion, and pathology was consistent with metastasis from the primary tumor. The urethra is a rare site of primary malignancy and metastatic disease. In particular, a non-contiguous metastatic disease involving the urethra is exceedingly rare. To the best of our knowledge, this is the first report of an AMA metastasizing to the urethra.

Keywords: Adenocarcinoma, mucinous; Appendiceal neoplasms; Magnetic resonance imaging; Urethral neoplasms.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Figure 1.
Figure 1.
MRI of the pelvis with gadolinium-based contrast for characterization and staging of the urethral lesion (long arrows). T2-weighted image on sagittal (A) shows a homogenous high signal involving the whole urethra. T2-weighted image on axial (B) evidences the abutment of the vagina superior to the introitus. DWI (C) with ADC mapping (D) reveals that the lesion does not show restricted diffusion; on the contrary, the lesion shows a T2 shine-through effect. Post-contrast axial images evidences rim enhancement of the lesion (E) and delineates the infiltration of surrounding tissues (F – short arrow).
Figure 2.
Figure 2.
Microscopy images with hematoxylin and eosin. 2× magnification (A) delineates mucinous adenocarcinoma (star) involving the muscularis layers of the urethra and periurethral tissue, represented by the overlying benign squamous mucosa (arrow head) and subepithelium (short arrow). 20× magnification (B) evidences that the tumoral cells form nests and trabecula or are floating in pools of mucin (star) involving the muscles bundles of the muscularis layers of the urethra (long arrow).
See this image and copyright information in PMC

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