A Rare Case of Advanced Urethral Diverticular Adenocarcinoma and a Review of Treatment Modalities

Abstract

Female urethral diverticular cancer is a very rare entity with only around 100 cases reported so far in literature and accounts for <1% of all malignancies. In this article, we present a 47-year-old African American female with repeated hospital visits for urinary retention, hematuria, and urinary tract infections. Initial computed tomography imaging and cystoscopy was unremarkable except for a distended urinary bladder. Subsequent magnetic resonance imaging and corresponding cystoscopy eventually indicated the presence of a urethral diverticulum. She underwent urethral diverticulectomy and was found to have a mass arising from urethral diverticulum extending to vaginal walls. Her biopsy was suggestive of invasive adenocarcinoma in advanced stages, for which she subsequently underwent a total pelvic exenteration. Next-generation sequencing of the tumor showed CDKN2A/B loss, MSI-stable, and low TMB, thereby ruling out the options for targeted therapies. Extensive literature search and expert opinions were sought for her case since no consensus exists regarding the optimal therapeutic approach due to the rarity of this tumor. A final decision was made to treat her with platinum-based chemotherapy. Different treatment approaches including neoadjuvant chemoradiation followed by surgery, surgery followed by adjuvant chemotherapy, and surgery followed by chemoradiation have been tried. Platinum-based chemotherapy has generally been preferred based on an extensive literature search. Multimodality treatment approach seems to be the current approach to management for advanced stages for better overall survival. This case illustrates the challenges faced in making diagnosis and treatment decisions due to the rarity of this type of tumor and lack of consensus in the treatment approach.

Acute urinary retention and risk of cancer: population based Danish cohort study

“…Limited evidence exists on the risk of cancer after acute urinary retention. Although several case reports have suggested that acute urinary retention can be the presenting sign of cancers other than prostate cancer, 23 24 25 26 27 28 29 30 no study has quantified this association. One study carried out at a hospital in the UK during 1979-80—before the era of prostate specific antigen—provided some evidence on the risk of cancer after acute urinary retention.…”

A giant calculus within urethral diverticulum causing urinary retention in an uncommunicative woman

“…3 Others have revealed that a large urethral diverticulum or advanced urethral diverticular adenocarcinoma can be the cause of urinary retention. 4,5 However, no report has described a calculus within the female urethral diverticulum, as a cause of acute urinary retention. We encountered the case of a bedridden and uncommunicative woman who had acute urinary retention due to a calculus within a urethral diverticulum, successfully treated by transurethral lithotripsy.…”

“…A prior case report revealed that a calculus within a female urethral diverticulum causes prolonged lower urinary tract symptoms such as dysuria 3 . Others have revealed that a large urethral diverticulum or advanced urethral diverticular adenocarcinoma can be the cause of urinary retention 4,5 . However, no report has described a calculus within the female urethral diverticulum, as a cause of acute urinary retention.…”

Divertículo uretral com transformação neoplásica do tipo intestinal: uma rara entidade

“…O objetivo deste relato foi apresentar um caso de adenocarcinoma do tipo intestinal originado a partir de um divertículo uretral com evolução metastática. 1,2 RELATO DO CASO Mulher de 56 anos, hipertensa, sem histórico de câncer na família, vem encaminhada por formação cística na porção superior do canal vaginal e sintomas de urge incontinência. Foi realizada RM que evidenciou formação cística circunferencial em terço médio da uretra medindo 3,8 x 1,8 cm.…”