Diagnosis of Female Urethral Cancer Based on Multimodal Ultrasound: A Case Report

Abstract

While histopathology remains the diagnostic gold standard for urothelial carcinoma, this case highlights the emerging role of advanced ultrasonographic techniques in characterizing urethral malignancies. We present a 51-year-old female with a one-month history of refractory lower urinary tract symptoms (urinary frequency, urgency, dysuria, and nocturia) unresponsive to conventional anti-inflammatory therapy. Multimodal ultrasonographic evaluation, incorporating conventional sonography, transrectal ultrasound, elastography, and contrast-enhanced ultrasonography (CEUS), revealed a complex proximal urethral mass with malignant features. Subsequent cystoscopic and histopathological examinations confirmed the diagnosis of primary urethral adenocarcinoma. This case underscores the diagnostic value of comprehensive ultrasound protocols in evaluating female urethral neoplasms.

Keywords: contrast-enhanced ultrasonography; female urethral adenocarcinoma; multimodal ultrasound; shear wave elasticity; transrectal biplane ultrasound.

Figure 1

Transperineal (convex probe) ultrasound (A) a moderately echogenic solid mass is seen in the proximal urethra, with clear borders, convexity to the bladder, and abundant blood flow signal. Transrectal (convex array probe) ultrasound (B) the shape of the mass is like a chestnut, similar to the male “prostate”, with disturbed vascularization. Transrectal (linear probe) ultrasound (C) the mass is slightly lobulated, which can clearly show multiple punctate echoes (white arrows) within the mass and distinguish the mass from the urethra and vagina.

Figure 2

Transrectal (wire-array probe) ultrasonography: slight increase in volume in contrast mode compared to gray scale, see that the lower wall of the bladder is also infiltrated with contrast, consider infiltration (A), the mass is fast-entering and fast-exiting with high enhancement (B).

Figure 3

Ultrasonic acoustic touch shear wave elasticity (A) max:62.92pka, mean:43.83pka; strain-based elasticity score (B) 5 points.