Cytologic Findings of Clear Cell Adenocarcinoma of the Urethra: A Case Report

Abstract

Clear cell adenocarcinoma of the urethra is a rare disease entity with an uncertain histogenesis. Here, we present a case of primary clear cell adenocarcinoma of the female urethra with its cytological findings. A 54-year-old woman presented with a painless gross hematuria lasting 3 months. On vaginal sonography, there was a sausage-like, elongated mass in the urethra, measuring 3.8×4.3 cm. The voided urine cytology revealed small clusters of rounded or papillary cells. The necrotic debris and inflammatory cells were present within some clusters of tumor cells. These tumor cells were enlarged and had abundant clear or granular cytoplasm with cytoplasmic vacuoles. The nucleus was granular and contained vesicular chromatin with prominent nucleoli. The hobnail cells and hyaline globules were also present as in a histologic section. The histologic findings were compatible with clear cell adenocarcinoma. The tumor showed distinctive cytological features. Cytologically, however, it is necessary to make a differential diagnosis from other adenocarcinoma or high-grade urothelial carcinoma.

Cytological and histological findings of upper tract mucinous urothelial carcinoma with clear cell component: A case report and review of literature

“…In most cases of adenocarcinoma, the nucleoli are prominent, the glandular component shows globular shape or three dimensional ball structures and its cytoplasm has vacuoles. 14 Although the intracytoplasmic mucin and glandular component which are frequently found in adenocarcinoma, they were not found in this case. Clear cell component is occasionally shown in conventional UC cases, but clear cell UC is exceedingly rare.…”

“…Cytological differential diagnoses in this case include adenocarcinoma or clear cell UC. In most cases of adenocarcinoma, the nucleoli are prominent, the glandular component shows globular shape or three dimensional ball structures and its cytoplasm has vacuoles 14 . Although the intracytoplasmic mucin and glandular component which are frequently found in adenocarcinoma, they were not found in this case.…”

Clear Cell Adenocarcinoma of the Urethra: Review of the Literature

“…Some authors [ 20 , 21 ] also stated that the response to chemotherapy is also not clear. Han et al [ 22 ] reported a 54-year-old woman who presented with painless visible haematuria. She had vaginal ultrasound scan which revealed a sausage-like elongated mass in the urethra.…”

Presentación de reporte de caso: adenocarcinoma de célula clara de uretra

“…El cáncer de uretra representa menos del 1% de las neoplasias genitourinarias en mujeres, entre sus tipos histológicos se encuentra el carcinoma urotelial de uretra, el cual es el tipo más frecuente de cáncer primario comprendiendo un 54-65% de los casos, seguido del carcinoma de células escamosas Presentación de reporte de caso: adenocarcinoma de célula clara de uretra González y col 16-22% y por último el adenocarcinoma de célula clara con una incidencia del 10-16%, este último es un tumor agresivo y poco frecuente en la población general, es más común en mujeres posmenopáusicas con un rango de edad entre los 35-80 años, con un promedio de presentación a los 58 años. 3,4 Esta enfermedad se ha relacionado con la alteración anatómica uretral como la presencia de divertículo uretral, el cual ha sido documentado en 1/3 de los casos reportados, sin embargo, la histogénesis no se ha dilucidado completamente. 5 Se ha propuesto que puede ser derivado del urotelio metaplásico, restos de Müller, glándulas periuretrales de Skene o de transformación maligna de un adenoma nefrogénico.…”

“…8 La radioterapia se debe utilizar en caso de compromiso linfático, mientras que la efectividad de quimioterapia no ha sido probada. 4 Por último, cabe resaltar que el cáncer de uretra tiene un pronóstico desfavorable dado la agresividad del tumor se han encontrado diversos factores relacionados con la supervivencia entre los cuales se encuentran: edad avanzada, estadio, compromiso ganglionar y metastásico, modalidad de tratamiento, tipo histológico y presencia concomitante de cáncer de vejiga. Estudios en Europa han observado una tasa de supervivencia para el cáncer de uretra a 5 años del 46%, a 10 años del 29% y en cuanto a supervivencia específica del cáncer uretral a 5 años la tasa fue del 68% y a 10 años del 60%.…”