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PubMed1976

Endoscopy and the detection of genitourinary carcinoma.

Endoscopy in the detection of urinary tract cancer is one of the primary tools of the urologist. It is used in the localization of bleeding sites, the systematic follow-up in detecting recurrent malignancies, the pathologic staging of carcinoma of the bladder through transurethral biopsy, and the identification and biopsy of primary transitional cell carcinoma of the prostate. It is also a prime tool in the diagnosis of ureteral and pelvic tumors through retrograde pyelography, brush biopsy, and urine collection for cytology. Nephroscopy is now also possible for the obscure lesions difficult to diagnose otherwise. Urethroscopy is also important in detecting malignant changes. The various sites for urologic cancer, their incidence, and the role of endoscopy in relation to other means of diagnosis and management are discussed.

Age Factors↗
PubMed1981

Mixed mucinous and papillary adenocarcinoma involving male urethra, probably originating in periurethral glands.

The case of a patient with primary adenocarcinoma involving the urethra is described. Morphologic evidence supporting an origin in the periurethral glands is presented. The urologist and pathologist must maintain a high index of suspicion in evaluating patients with urethral structure or urethrocutaneous fistulae because superficial transurethral biopsy may fail to obtain adequate depth to demonstrate malignancy.

Adenocarcinoma, Mucinous↗
PubMed1986

Prostatic involvement in bladder cancer. Prostate mapping in 20 cystoprostatectomy specimens.

Twenty prostate glands from patients with either high-grade papillary tumors (19 patients, 15 of whom also had peripheral carcinoma in situ) or multifocal carcinoma in situ (1 patient) of the bladder who underwent cystoprostatectomy were studied histologically by mapping. Prostatic duct involvement by urothelial carcinoma was noted in nine patients, two with extensive involvement and seven with focal involvement confined to periurethral ducts. Carcinoma in situ of the bladder was observed in each of the nine patients and intraepithelial permeation appeared to be the predominant manner of spread of cancer cells into the prostate. The prostatic involvement was clinically silent and it may be a potential source of failure of conservative modalities of treatment of high-grade bladder cancer. A routine diagnostic transurethral prostatic biopsy may be recommended in the workup of patients with carcinoma in situ and high-grade carcinomas of the bladder. An incidental observation was the presence of 14 occult prostatic adenocarcinomas.

Acid Phosphatase↗
PubMed1987

Malignant melanoma of the penis and male urethra. Report of nine cases and review of the literature.

Nine cases of primary malignant melanoma of the penis and male urethra are presented. The age range of the patients was 57-77 years. Five patients had intermittent bleeding, one had pain, and three were asymptomatic. Six patients had the melanoma on the glans or prepuce and three in the urethra; two presented with inguinal lymph node metastases. Penile amputation was performed in six patients, local excision in three, groin dissection in four, and one was given radiotherapy. Postoperative metastases were seen in eight patients, four of whom were treated with surgery, alone or in combination with radiotherapy, and one with chemotherapy. Two patients are still living, at 2 and 14 years after diagnosis, respectively. Seven patients have died of their tumors, five of them within 2 years. This confirms the consensus of available reports that, irrespective of what type of therapy is used, prognosis is poor in patients with malignant melanoma of the penis and urethra.

Aged↗
PubMed1989

Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse.

Of 133 patients with advanced urothelial tract cancer given methotrexate (MTX), vinblastine (VBL), Adriamycin (ADR) (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (DDP) (M-VAC regimen), significant tumor regression occurred in 72% +/- 8% of 121 with transitional cell carcinoma (TCC) evaluable for response. Complete remission (CR) was achieved in 36% +/- 9% of patients, of whom 11% required the addition of surgical resection of residual disease. Although 68% of CR patients have relapsed, CR median survival will exceed 38 months compared with 11 months for partial (36%) and minor (6%) responders, and 8 months for nonresponders: 2-year and 3-year survivals were 68% and 55%, respectively, versus 0% to 7% for the remaining patients. Sixteen percent of responders developed brain lesions, half of whom had no systemic relapse at the time of progression. Three patients with non-TCC histologies did not respond. In 32 patients who had pathologic restaging, the clinical (T) understaging (T less than pathologic [P] restaging) error was 35%. Although all metastatic sites showed evidence of tumor regression, CR was noted more frequently in lung, in intraabdominal lymph nodes and masses, and in bone (24% to 35%); the rate for hepatic lesions was 15%. There were 52% of 21 N3-4M0 patients who achieved CR versus 33% of 100 with N0-+M+ lesions. Toxicity was significant with 4 (3%) drug-related deaths, 25% incidence of nadir sepsis, 58% greater than or equal to 3+ myelosuppression, and 49% with mucositis. Responsiveness of metastasis in various sites, patterns of relapse, and the usefulness of the new CR response criteria are reported, as is the current status of cisplatin and methotrexate combination regimens.

Adult↗
PubMed1981

Malignant melanoma of the female genital system: a report of 48 patients and review of the literature.

Malignant melanoma of the female genital tract comprises 3% of all melanomas afflicting females. Melanoma of the vulva is most common, comprising 45 patients treated by the author. Thirty-two percent had metastases to the regional lymph nodes on presentation. Five-year survival is 31.6%. Radical vulvectomy and radical groin dissection is the treatment of choice. Only 80 melanomas of the vagina have been reported, with cures being an extreme rarity. Forty cases of the female urethra reported in the literature and only five survivors have been reported. Melanoma of the uterus is extremely rare, with no cures recorded. Melanoma of the ovary may occur within a teratoma but most frequently is metastatic.

Adolescent↗
PubMed2000

Female urethral adenocarcinoma arising from urethritis glandularis.

INTRODUCTION: Female urethral adenocarcinoma is extremely rare and more than one tissue of origin has been suggested other than the Skene's gland. Immunohistochemistry with cytokeratins (CK) 7 and 20 is used to define the origin of the tumor. CASE REPORT: A 72-year-old woman presented with a 2-cm polypoid tumor at the external urethral meatus and bleeding. Wide local excision and bilateral inguinal lymphadenectomy were performed. Postoperative convalescence was uneventful. It was a poorly differentiated mucinous adenocarcinoma without direct urothelial involvement. There were focal areas of intestinal metaplasia. The tumor cells were positive for CK 7 and 20 and negative for prostate-specific antigen. DISCUSSION: This case provides supportive evidence that mucinous urethral adenocarcinoma may arise from malignant transformation of urethritis glandularis.

Adenocarcinoma↗
PubMed1994

The effect of dose intensity on M-VAC therapy for advanced urothelial cancer.

M-VAC therapy (methotrexate, vinblastine, Adriamycin, and cisplatin) has improved the treatment results of urothelial cancer patients. However, it is sometimes complicated by drug toxicities, including bone marrow suppression. We analyzed the relative dose intensity in each patient undergoing M-VAC chemotherapy in relation to the chemotherapeutic effect and survival. In addition, the role of granulocyte colony-stimulating factor (G-CSF) in the dose intensity of M-VAC therapy was analyzed. Between June 1988 and March 1993, 29 patients with advanced urothelial cancer were treated with M-VAC therapy in our institution. Of 18 patients with evaluable lesions, 2 (11.1%) showed a complete response (CR) and 7 (38.9%) showed a partial response (PR), and the overall response rate was 50.0%. The median follow-up period for these 18 patients was 14.6 months and the median survival was 8.7 months, with 12 of the 18 patients being alive at the time of analysis. The relative dose intensity (RDI) for these 18 patients was 0.81 for methotrexate, 0.80 for vinblastine, 0.92 for Adriamycin, and 0.91 for cisplatin, for a mean RDI of 0.87. There was no correlation between the chemotherapeutic effect and the RDI. When we calculated the RDI for all 29 patients who underwent M-VAC therapy, G-CSF increased the RDI of Adriamycin significantly. The results of this retrospective study indicate that a dose intensity for M-VAC therapy in the range of 0.61-1.00 is unlikely to correlate with the chemotherapeutic effect, although G-CSF contributes to increasing the RDI of Adriamycin.

Adenocarcinoma↗
PubMed1987

Tumour of female paraurethral duct. Immunohistochemical similarity with prostatic carcinoma.

A case of adenocarcinoma derived from a female paraurethral duct is described. Morphologically the tumour looked like a prostatic adenocarcinoma. Furthermore, the tumour cells stained positively with antibodies to prostatic specific antigen and prostatic specific acid phosphatase. The karyotype of the patient was 45,x/46,xx/47,xxx/46,xt(x;13)(p11;q22) demonstrating that the patient was not a hermaphrodite. The tumour therefore represented female homology of a prostatic adenocarcinoma.

Adenocarcinoma↗
PubMed1983

Sonographic diagnosis of urethral polyp in a child.

Congenital urethral polyps are an uncommon cause of urethral obstruction in male children. The diagnosis is obtained at voiding cystography by demonstrating a filling defect which (typically) moves during micturition. A small polypoid mass with a stalk arising from the region of the verumontanum was observed by sonography in one such patient. We believe sonographic findings may be considered specific of this condition.

Child↗
PubMed1983

Acquired obstructions of the lower urinary tract in children.

Acquired obstructions of the lower urinary tract in children are uncommon. They can be divided into intrinsic and extrinsic lesions, and have a very varied etiology. Several illustrative cases are reported, such as traumatic and infectious strictures, meatal stenosis, benign and malignant tumors, fused labia, and epidermolysis bullosa. Many of these lesions have distinct radiographical features, best demonstrated by micturating cystourethrograms.

Adolescent↗
PubMed2005

[Mesonephric carcinoma of the urethra. A case report].

Mesonephric carcinoma is a tumor entity that rarely develops in the neck of the uterus and vaginal wall and is extremely unusual in the urinary bladder or paraurethral tissue. The tumors arise in the remnants of the wolffian or mesonephric duct. The malignant potential is considered to be lower than in tumors of the urethra with different histologic findings. Anterior pelvic exenteration is recommended in the literature as the treatment of choice. In the case described here, the tumor presented as a space-occupying lesion in a urethral diverticulum exhibiting striking clinical features of macrohematuria and urinary retention with subvesical obstruction of the urethra. In accordance with reports in the literature, cystectomy was performed and a Kock pouch constructed for urinary diversion. Tumors occurring in a diverticulum-and in this case manifesting as the rare tumor form of mesonephric carcinoma-should always be included in the differential diagnosis of macrohematuria in women.

Aged↗
PubMedDate not supplied

Primary isolated urethral amyloidosis.

We report an unusual case of primary amyloidosis isolated to the urethra in a patient with tender, periurethral masses and obstructive voiding symptoms. When not secondary to other phenomena, amyloidosis most commonly affects the skin, respiratory, and urinary tracts. Isolated amyloidosis of the urethra should be in the differential diagnosis of a patient with irregular strictures of the penile urethra, a clinical presentation consistent with urethral carcinoma, and no evidence of systemic disease.

Adult↗