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1.
Hinyokika Kiyo ; 70(3): 71-75, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38961698

RESUMO

We report a case of small cell carcinoma of the urethra with inguinal lymph node metastases. A 50- year-old female patient presented with gross hematuria. Cystoscopy and computed tomography (CT) revealed a tumor surrounding the urethra and an inguinal lymphadenopathy. Biopsy of the urethral tumor demonstrated small cell carcinoma. Four courses of chemotherapy with etoposide and cisplatin, followed by 66 Gy of irradiation achieved complete remission. Unfortunately, 14 months later, positroemission-CT scan revealed recurrence of inguinal lymph node metastases. Although seven courses of chemotherapy with nogitecan were carried out, a new metastatic bone tumor developed. Amrubicin was administered as a third-line treatment, but was canceled after one course because of side effects. The patient died at 39 months after diagnosis. Small cell carcinoma of urethra with metastases has extremely poor prognosis, as is demonstrated by this case.


Assuntos
Carcinoma de Células Pequenas , Neoplasias Uretrais , Humanos , Feminino , Pessoa de Meia-Idade , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/terapia , Carcinoma de Células Pequenas/patologia , Neoplasias Uretrais/patologia , Neoplasias Uretrais/diagnóstico por imagem , Neoplasias Uretrais/terapia , Metástase Linfática , Evolução Fatal , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tomografia Computadorizada por Raios X
4.
Medicine (Baltimore) ; 103(20): e37893, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38758882

RESUMO

RATIONALE: Leiomyoma is a benign smooth muscle tumor which is rarely found in urethra. We hereby report a case of a 44-year-old female who presented with complaints of dysuria. PATIENT CONCERNS: A 44-year-old female patient presented to the urology outpatient clinic with symptoms of dysuria. The patient described the presence of a protrusion from the urethra during urination. DIAGNOSIS: Urethral leiomyoma. INTERVENTIONS: Physical examination confirmed a solid urethral mass. CT scan and USG reports indicated that the mass originated from the mid-urethra with vascularity at the base. We performed a complete resection of the urethral mass. The patient was discharged after 3 days of observation. OUTCOME: During a follow-up after 1 month, the patient reported improved urinary flow and no occurrence of hematuria. The patient recovered well after discharge. LESSON: Urethral leiomyoma is a rare benign tumor that is often misdiagnosed in clinical practice. Diagnosis requires careful clinical examination. Surgical removal usually works well. It is important to remember that in some cases of acute urinary retention, it can be caused by a complete obstruction of a mass in the urethra. Urologists should be more cautious and experienced in handling such cases.


Assuntos
Disuria , Leiomioma , Neoplasias Uretrais , Humanos , Feminino , Leiomioma/cirurgia , Leiomioma/diagnóstico , Leiomioma/complicações , Leiomioma/patologia , Leiomioma/diagnóstico por imagem , Adulto , Disuria/etiologia , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/cirurgia , Neoplasias Uretrais/patologia , Tomografia Computadorizada por Raios X
5.
Urol Oncol ; 42(9): 290.e11-290.e16, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38688797

RESUMO

PURPOSE: To describe the incidence and management of patients who develop a prostatic urethral (PU) urothelial carcinoma recurrence after Bacillus Calmette-Guerin (BCG) induction for non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS: We performed a retrospective cohort study of all patients who received BCG induction at our institution from 1996 to 2021 (N = 642) for NMIBC. All patients with pathologically confirmed PU involvement following BCG induction with no known PU involvement pre-BCG were included. We describe the presentation, management, and outcomes for PU recurrence. RESULTS: Among the 642 patients, 21 (3.3%) patients had a PU recurrence after BCG induction. 8 (38%) patients received >2 cycles of BCG induction prior to the recurrence. Median time from induction to PU recurrence was 21 months and 12 (57.1%) patients had concurrent bladder recurrence. At the time of their PU recurrence, 14/21 (67%) of patients were deemed BCG Unresponsive. Nearly all (18/21) were high grade, and 10 were stage Tis, 7 Ta, and 3 T1, and 1 T2. 19/21 (90%) patients received bladder sparing treatment: 6 with TURBT and BCG, 6 with TURBT and intravesical chemotherapy, 5 with TURBT only, and 2 did not receive immediate treatment of their PU recurrence due to advanced stage of disease. 2/21 (9.5%) received a radical cystectomy for initial treatment of the post-BCG PU recurrence, of which all were >pT2. Median follow-up time from BCG induction to the patient's last visit was 64.5 months. Following treatment of PU recurrence, 15/18 patients had another recurrence at a median of 5 months: about 47% of recurrences were bladder only and 14% recurred only in the PU as well. About 1 patient received a RC after the second recurrence and was pT2. CONCLUSION: Patients with PU recurrences following intravesical BCG have a high-risk disease phenotype with a significant risk of recurrence. Conservative management may be appropriate for well-selected patients who do not desire a cystoprostatectomy.


Assuntos
Vacina BCG , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Masculino , Vacina BCG/uso terapêutico , Vacina BCG/administração & dosagem , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Incidência , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Invasividade Neoplásica , Estudos de Coortes , Neoplasias Uretrais/terapia , Neoplasias Uretrais/patologia , Adjuvantes Imunológicos/uso terapêutico , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/terapia , Carcinoma de Células de Transição/patologia , Neoplasias não Músculo Invasivas da Bexiga
7.
Can J Urol ; 31(2): 11858-11860, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38642465

RESUMO

Urethral cancer after urethral reconstruction is an under-recognized, uncommon disease associated with significant morbidity and mortality. The survival rates of patients with carcinoma of the bulbar urethra are as low as 20%-30%. Stricture recurrence and unrecognized malignant changes present prior to reconstruction are major risk factors for urethral cancer. Skin substitution urethroplasty is subjected to higher rates of recurrence, which lends to the potential for carcinogenesis. We present a case of a 59-year-old male who underwent multi-stage skin substitution urethroplasty who developed urethral carcinoma 20 years later.


Assuntos
Neoplasias Uretrais , Estreitamento Uretral , Masculino , Humanos , Pessoa de Meia-Idade , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Estreitamento Uretral/patologia , Neoplasias Uretrais/cirurgia , Neoplasias Uretrais/etiologia , Estudos Retrospectivos , Mucosa Bucal , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Resultado do Tratamento
8.
Urol Oncol ; 42(7): 221.e17-221.e22, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38627106

RESUMO

BACKGROUND: In metastatic urethral cancer, temporal trends, and patterns of inpatient palliative care (IPC) use are unknown. METHODS: Relying on the National Inpatient Sample (2006-2019), metastatic urethral cancer patients were stratified according to IPC use. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models (LRM) for the prediction of IPC use were fitted. RESULTS: Of 1,106 metastatic urethral cancer patients, 199 (18%) received IPC. IPC use increased from 5.8 to 28.0% over time in the overall cohort (EAPC +9.8%; P < 0.001), from <12.5 to 35.1% (EAPC +11.2%; P < 0.001), and from <12.5 to 24.7% (EAPC +9.4%; P = 0.01) in respectively females and males. Lowest IPC rates were recorded in the Midwest (13.5%) vs. highest in the South (22.5%). IPC patients were more frequently female (44 vs. 37%), and more frequently exhibited bone metastases (45 vs. 34%). In multivariable LRM, female sex (multivariable odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05-2.02; P = 0.02), and bone metastases (OR 1.46, 95%CI 1.02-2.10; P = 0.04) independently predicted higher IPC rates. Conversely, hospitalization in the Midwest (OR 0.53, 95%CI 0.31-0.91; P = 0.02), and in the Northeast (OR 0.48, 95%CI 0.28-0.82; P = 0.01) were both associated with lower IPC use than hospitalization in the West. CONCLUSION: IPC use in metastatic urethral cancer increased from a marginal rate of 5.8% to as high as 28%. Ideally, differences according to sex, metastatic site, and region should be addressed to improve IPC use rates.


Assuntos
Cuidados Paliativos , Neoplasias Uretrais , Humanos , Masculino , Feminino , Cuidados Paliativos/estatística & dados numéricos , Idoso , Neoplasias Uretrais/terapia , Pessoa de Meia-Idade , Hospitalização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Metástase Neoplásica , Estudos Retrospectivos
9.
J Surg Oncol ; 129(7): 1348-1353, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38606531

RESUMO

BACKGROUND: We examined the effect of disease-free interval (DFI) duration on cancer-specific mortality (CSM)-free survival, otherwise known as the effect of conditional survival, in radical urethrectomy nonmetastatic primary urethral carcinoma (PUC) patients. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) database 2000-2020, patient (age, sex, race/ethnicity, and marital status) and tumor (stage and histology) characteristics, as well as systemic therapy exposure status of nonmetastatic PUC patients were tabulated. Conditional survival estimates at 5-year were assessed based on DFI duration and according to stage at presentation (T1 -2N0 vs. T3-4N0-2). RESULTS: Of all 512 radical urethrectomy PUC patients, 278 (54%) harbored T1-2N0 stage versus 234 (46%) harbored T3-4N0-2 stage. In 512 PUC patients, 5-year CSM-free survival at initial diagnosis was 61.8%. Provided a DFI duration of 36 months, 5-year CSM-free survival was 85.6%. In 278 T1-2N0 PUC patients, 5-year CSM-free survival at initial diagnosis was 68.4%. Provided a DFI duration of 36 months, 5-year CSM-free survival was 86.9%. In 234 T3-4N0-2 PUC patients, 5-year CSM-free survival at initial diagnosis was 53.8%. Provided a DFI duration of 36 months, 5-year CSM-free survival was 83.6%. CONCLUSIONS: Although intuitively, clinicians and patients are well aware of the concept that increasing DFI duration improves survival probability, only a few clinicians can accurately estimate the magnitude of survival improvement, as was done within the current study. Such information is crucial to survivors, especially in those diagnosed with rare malignancies, where the survival estimation according to DFI duration is even more challenging.


Assuntos
Programa de SEER , Neoplasias Uretrais , Humanos , Masculino , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/cirurgia , Neoplasias Uretrais/patologia , Feminino , Taxa de Sobrevida , Pessoa de Meia-Idade , Idoso , Seguimentos , Prognóstico , Adulto , Estadiamento de Neoplasias , Intervalo Livre de Doença
11.
Fr J Urol ; 34(5): 102606, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38437949

RESUMO

Primary urethral carcinoma (PUC) is defined as a tumor process arising within the urethra, with no history of other urinary tract localization or synchronous tumor of the urinary tract. The most common histological types are urothelial carcinoma (UC), squamous cell carcinoma (SCC) and adenocarcinoma (AC). In men, UC predominates, while AC is rare. In women, AC affects around one in two patients, while EC and UC are equally divided between the remaining cases. Diagnosis is often delayed, and requires endoscopic examination with biopsies. MRI is the gold standard for local staging. FDG-PET scan can help in cases of doubt about regional or distant extension. The prognosis remains unfavorable despite aggressive surgical treatment. Multimodal management combining surgery, radiotherapy and chemotherapy appears to improve prognosis in severe forms.


Assuntos
Neoplasias Uretrais , Humanos , Neoplasias Uretrais/terapia , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/patologia , Masculino , Feminino , Estadiamento de Neoplasias , Carcinoma de Células Escamosas/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagem , França/epidemiologia , Adenocarcinoma/terapia , Adenocarcinoma/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Prognóstico , Carcinoma de Células de Transição/terapia , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/diagnóstico por imagem , Imageamento por Ressonância Magnética
12.
Asian J Surg ; 47(1): 505-512, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37330300

RESUMO

BACKGROUND: Primary urethral melanoma is extremely rare and malignant, and accounts for <1% of all melanoma cases. Here, we aimed to gain more insight into the pathological and follow-up outcomes of patients with this tumor type. METHODS: We conducted a retrospective analysis of nine patients who had undergone comprehensive treatment at West China Hospital since 2009. Furthermore, we also performed a questionnaire-based survey to determine the quality of life and health statuses of surviving patients. RESULTS: Most participants were women, and their ages ranged between 57 and 78 years (mean age: 64.9 years). Common clinical presentations included pigmentation, moles, and irregular neoplasms in the urethral meatus with or without bleeding. The final diagnosis was based on pathological and immunohistochemical examination results. All patients underwent regular follow-ups after receiving surgical or non-surgical therapy, such as chemotherapy or radiotherapy. DISCUSSION/CONCLUSION: Our study revealed that pathological and immunohistochemical tests are crucial for precise diagnosis, especially in asymptomatic patients. Primary malignant urethral melanoma generally has a poor prognosis; therefore, early and accurate diagnosis is imperative. Timely surgical intervention and immunotherapy can help improve patient prognosis. Moreover, an optimistic outlook and family support may augment the clinical management of this disease.


Assuntos
Melanoma , Neoplasias Uretrais , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Melanoma/diagnóstico , Melanoma/terapia , Melanoma/patologia , Uretra , Estudos Retrospectivos , Qualidade de Vida , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/terapia , Neoplasias Uretrais/patologia
16.
BMJ Case Rep ; 16(12)2023 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-38086572

RESUMO

The incidence of urethral recurrence after radical cystectomy is 1% to 8%, with most cases occurring within the first 2 years of surgery. Prophylactic urethrectomy is rarely performed nowadays due to no known survival benefit and increased morbidity due to the procedure. However, we encountered a rare case of delayed urethral recurrence presenting as recurrent urethral collection 4 years after radical cystectomy with ileal conduit diversion, posing a diagnostic dilemma.


Assuntos
Neoplasias Uretrais , Neoplasias da Bexiga Urinária , Derivação Urinária , Humanos , Cistectomia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/cirurgia , Uretra/cirurgia , Recidiva Local de Neoplasia/cirurgia
17.
Front Immunol ; 14: 1254812, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37901233

RESUMO

Primary urethral carcinoma (PUC) has a low incidence, but with high aggressiveness. Most of the patients are found in late stage, with poor prognosis. At present, chemotherapy is still the main treatment for metastatic PUC, but it has limited effect. Here, we report a case of metastatic PUC with low HER2 expression that developed disease progression after multiline therapy including chemotherapy, programmed death-1 (PD-1) inhibitors and multi-targeted receptor tyrosine kinase (RTK) inhibitor. After receiving Disitamab Vedotin(a novel antibody drug conjugate, ADC) and toripalimab (a PD-1 inhibitor), the patient achieved persistent PR, and the PFS exceeded 12 months up to now. Our report indicates that, despite the patient of metastatic PUC has low expression of HER2, it is still possible to benefit from Disitamab Vedotin combined with PD-1 inhibitor, which may reverse the drug resistance of PD-1 inhibitor and chemotherapy to a certain extent. But larger sample studies are needed to determine the efficacy of this treatment strategy and its impact on survival.


Assuntos
Imunoconjugados , Neoplasias Uretrais , Humanos , Neoplasias Uretrais/tratamento farmacológico , Inibidores de Checkpoint Imunológico
18.
Clin Nucl Med ; 48(12): e575-e576, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37844329

RESUMO

ABSTRACT: Primary urothelial urethral cancer is a relatively infrequent but serious form of cancer in the urinary tract, and nested variant is extremely rare. Until now, no studies have been published regarding 18 F-FDG PET/CT in patients with primary urothelial urethral cancer. In this study, we discussed the role of 18 F-FDG PET/CT in the initial staging, treatment response evaluation, and recurrence assessment of a 53-year-old woman with nested variant urothelial urethral cancer, which could lead to timely diagnosis and evaluation of the extent of involvement, thus achieving the best treatment plan for this group of patients.


Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Uretrais , Feminino , Humanos , Pessoa de Meia-Idade , Fluordesoxiglucose F18 , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
19.
Curr Opin Obstet Gynecol ; 35(6): 517-524, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37678190

RESUMO

PURPOSE OF REVIEW: Female periurethral masses are an uncommon occurrence. The purpose of this review is to describe etiologies of female urethral and periurethral masses and to provide an update on diagnosis and management. RECENT FINDINGS: The most common causes of periurethral and urethral masses in women are urethral caruncles, urethral diverticula, and Skene's gland cysts. Urethral meatal lesions such as urethral caruncles and prolapse can be managed conservatively with topical estrogen therapy and close follow-up or should be excised in the setting of thrombosis, significant or recurrent bleeding, acute urinary retention, or persistent pain. Benign periurethral gland masses, such as Skene's gland cysts, Gartner's duct cysts, and Mullerian duct cysts, remain rare. Recent case series reveal a high rate of surgical management of these lesions with few complications. Urethral malignancy or malignant transformation of benign etiologies are even rarer but can be aggressive in nature and should be treated promptly. SUMMARY: Nonspecific urinary and vaginal symptoms as well as similar physical presentations make diagnosis of urethral and periurethral lesions in females difficult. Magnetic resonance imaging is useful for differentiation of periurethral masses. The decision for conservative or surgical management is typically guided by patient symptom bother, as well as concern for urethral malignancy.


Assuntos
Cistos , Doenças Uretrais , Neoplasias Uretrais , Feminino , Humanos , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/terapia , Uretra/cirurgia , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Imageamento por Ressonância Magnética/métodos , Cistos/diagnóstico , Cistos/cirurgia
20.
Ann Pathol ; 43(6): 491-494, 2023 Nov.
Artigo em Francês | MEDLINE | ID: mdl-37716866

RESUMO

We report a case of primary melanoma of a female urethra diagnosed at a non-metastatic stage in a 48-year-old patient with a history of breast carcinoma treated with radiotherapy and hormone therapy. The patient was consulting for dysuria, hematuria, and perineal pain. The clinical examination found a prolapsed and black mass, developed at the expense of the urethra and located at the anterosuperior part of the vulva. The mass biopsy revealed a proliferation of fusiform and globular cells loaded with black pigment expressing the anti-HMB 45 and PS 100 antibodies. The extension assessment showed an absence of secondary localization. The patient underwent total cystourethrectomy without inguinal lymphadenectomy. There was no recurrence observed on day 100 following the surgery.


Assuntos
Neoplasias da Mama , Melanoma , Neoplasias Uretrais , Humanos , Feminino , Pessoa de Meia-Idade , Uretra/patologia , Uretra/cirurgia , Neoplasias Uretrais/diagnóstico , Neoplasias Uretrais/patologia , Neoplasias Uretrais/cirurgia , Melanoma/patologia , Vulva/patologia
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