Vulva & female urethra
Female urethra
Female urethral carcinoma


Topic Completed: 1 April 2016

Revised: 9 May 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Urethral carcinoma[title] female
Page views in 2019 to date: 19
Cite this page: Chavez J. Female urethral carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvafemaleurethralcarcinoma.html. Accessed May 24th, 2019.
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:
    • 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
      • May arise from urothelial metaplastic mucosa or from periurethral glands in both sexes
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

Contributed by Dr. Jesus Chavez and Dr. Debra Zynger

Urethra and periurethral tissue

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

Contributed by Dr. Jesus Chavez and Dr. Debra Zynger

High power, low grade

Noninvasive high grade

Invasive high grade

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
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