Urethra
General
Urethral carcinoma

Author: Jesus A. Chavez, M.D. (see Authors page)
Editor: Debra L. Zynger, M.D.

Revised: 10 November 2017, last major update April 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Urethral carcinoma[title]
Cite this page: Chavez, J.A. Urethral carcinoma - general. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/urethracarcinoma.html. Accessed November 20th, 2017.
Definition / general
  • Rare primary neoplasm of epithelial origin
  • Secondary involvement by urothelial carcinoma of the bladder is much more common than a primary (Eur Urol 2013;64:823)
Essential features
  • Urethral carcinoma is usually due to secondary involvement
  • Primary urethral carcinoma is rare and the most frequent histologic types are urothelial carcinoma, squamous cell carcinoma and adenocarcinoma (not otherwise specified, clear cell)
Epidemiology
Sites
  • Type depends on sex and location:
    • Male urethra divided into four anatomic regions: prostatic, membranous, bulbous and penile
    • Female urethra divided in proximal 2/3 and distal 1/3
      • Proximal 2/3 usually urothelial carcinoma
      • Distal 1/3 usually squamous cell carcinoma (BJU Int 2014;114:25)
      • Frequently initially misdiagnosed as caruncle
    • Adenocarcinoma present in both sexes; may originate anywhere along the urethra
Pathophysiology
  • Predisposing factors include:
Clinical features
  • Most patients present with symptoms associated with locally advanced disease (Eur Urol 2013;64:823)
    • Gross hematuria or bloody urethral discharge, dysuria, extraurethral mass
    • Bladder outlet obstruction, pelvic pain, urethrocutaneous fistula
    • Abscess formation, dyspareunia
  • Approximately 1/3 of men and women present with involved regional lymph nodes
Diagnosis
  • Clinical examination with palpation of external genitalia for suspicious indurations and pelvic exam in women (Eur Urol 2013;64:823)
  • Urinary cytology
  • Diagnostic urethroscopy and biopsy
Radiology description
  • Aims to assess local extent and detect lymphatic and distant metastatic spread
  • Magnetic resonance imaging for evaluating extent of tumor and monitoring response to neoadjuvant chemotherapy (Eur Urol 2013;64:823)
Prognostic factors
Case reports
Treatment
Gross images

Images hosted on PathOut server:

Contributed by Dr. Jesus Chavez and Dr. Debra Zynger, The Ohio State University / Wexner Medical Center (USA):

Urethra
and periurethral tissue

Penile urethra
with periurethral involvement

Microscopic (histologic) description
  • Urothelial carcinoma
  • Squamous Cell Carcinoma
    • Sheets of large, pleomorphic tumor cells with focal or abundant keratinization (depending of grade of differentiation), ample cytoplasm, intercellular bridges, high mitotic activity, prominent nuclear atypia
  • Adenocarcinoma
  • Clear Cell Adenocarcinoma
    • May have glandular, tubulocystic, solid/diffuse, papillary or micropapillary growth patterns
    • Cuboidal, variably sized cells with abundant clear or eosinophilic cytoplasm and cytoplasmic vacuoles
    • Nuclei that are hyperchromatic, pleomorphic and have prominent nucleoli
    • Hobnail changes and extracellular mucoid material may be present
    • Mitoses and necrosis are often seen
Microscopic (histologic) images
Images hosted on PathOut server:

Contributed by Dr. Jesus Chavez and Dr. Debra Zynger, The Ohio State University / Wexner Medical Center (USA):

Low power, low grade

High power, low grade

Noninvasive high grade

Invasive high grade


Penile urethra, squamous cell carcinoma

Penile urethra, HPV+ high risk ISH

Necrosis and keratinization

Elderly woman: metastatic



Clear cell adenocarcinoma:

Low power, prominent necrosis

Can mimic nephrogenic metaplasia

With hobnailing

With prominent clear cells and diffuse, sheet-like growth

Positive stains
Negative stains
Differential diagnosis