Adenocarcinoma of the urethra in women. A clinicopathologic study

Abstract

Twenty-two cases of adenocarcinoma of the urethra in women were studied. Nine were classified histologically as clear cell adenocarcinoma and 13 were classified as columnar/mucinous adenocarcinoma. Thirteen patients (59%) were black. The average patient age was 61 years (range, 27 to 76 years). Follow-up ranged from 6 to 194 months, (average, 40 months). At presentation, most patients (82%) had extension of tumor into adjacent structures or metastases to regional lymph nodes. Eighty-six percent received radiation therapy and 41% underwent an anterior exenteration or cystectomy. Eight of 22 patients (36%) had no evidence of disease 21 to 194 months after diagnosis (average, 83 months). Fourteen (64%) were dead of disease 6 to 23 months after diagnosis (average, 15 months). In general, the extent of tumor correlated best with survival time. Forty-four percent of patients with clear cell adenocarcinoma were dead of disease within 24 months of diagnosis, in contrast to 77% of those with columnar/mucinous adenocarcinoma, suggesting that patients with clear cell adenocarcinoma may have a better prognosis than those with columnar/mucinous adenocarcinoma. However, the difference in survival probability between the two groups was not found to be statistically significant. Recognition of the two histologic types of urethral adenocarcinoma is important to prevent misdiagnosis of such tumors as metastases (or direct extension) of nonurethral neoplasms having a similar histologic appearance. A possible predilection of the disease for black women has not been previously described.

Histogenesis of Clear Cell Adenocarcinoma in the Urinary Tract: Evidence of Urothelial Origin

“…Characteristic clear tumor cell cytoplasm and hobnail tumor cells appeared in the majority of cases. All above histologic presentations were similar to the findings in the previous literatures (6, 16,44,45). In our study, neither Mü llerian remnant, a clue of Mü llerian origin as its genital counterpart, nor intestinal metaplasia, a common feature present in vesical adenocarcinoma of non-Mü llerian origin, was identified.…”

Skene's Gland Adenocarcinoma Resembling Prostatic Adenocarcinoma

“…The most common histologic types are squamous cell and transitional cell carcinomas (1,4). Adenocarcinomas of the urethra are the least common type of urethral carcinoma in women, accounting for only 10% of all primary urethral cancers in this group (1,2,10,11).…”

“…Primary adenocarcinomas of the urethra in women have been classified by their histologic and histochemical features as clear cell versus nonclear cell adenocarcinomas (8) enocarcinomas (1). Recently, tumor markers and immunohistochemistry have been used to further characterize these neoplasms.…”

“…Primary urethral carcinomas in women are extremely rare (1)(2)(3); most are squamous cell or transitional cell carcinomas (1,2,4,5). Adenocarcinomas of the urethra account for less than 0.003% of all urogenital tract malignancies in women (3,6,7).…”

“…Adenocarcinomas of the urethra account for less than 0.003% of all urogenital tract malignancies in women (3,6,7). The three major histologic subtypes are clear cell adenocarcinoma, columnar cell/mucinous adenocarcinoma, and the rarest, adenocarcinoma resembling prostatic adenocarcinoma (1,8). Although adenocarcinomas arising in the periurethral area in women have been assumed to have originated in Skene's glands (1,6,9,10), more recent studies have suggested a diverse histogenesis for the different subtypes (4,6,9,11).…”