Primary mucin-producing urothelial-type adenocarcinoma of the prostatic urethra diagnosed on TURP: a case report and review of literature.

BACKGROUND: Mucin-producing urothelial-type adenocarcinoma of the prostatic urethra is extremely rare. These lesions must be differentiated from other mucinous tumors including mucin-producing prostatic adenocarcinoma and metastases from either colonic or bladder primaries. CASE PRESENTATION: We report here a case of urothelial-type adenocarcinoma arising from the prostatic urethra. The patient is an 81 year-old man with a history of pT1 urothelial cell carcinoma of the bladder status post trans-urethral resection of bladder tumor (TURBT) who initially presented with irritative lower urinary tract symptoms and mucosuria refractory to Flomax and finasteride. A shared decision was made for the patient to undergo trans-urethral resection of prostate (TURP). At the time of surgery, a papillary tumor emanating from the prostatic urethra was found and no urothelial lesions were noted in the bladder. Pathology of the resected prostatic chips revealed an invasive adenocarcinoma with intestinal-type differentiation that stained positive for CK7, CK20, and villin, but negative for PSA, PSAP, uroplakin, and CDX-2. Colonoscopy was normal and CT scan did not show any evidence of colonic lesions nor visceral or lymph node metastases. Thus, the patient was diagnosed with a primary urothelial-type adenocarcinoma of the prostatic urethra. CONCLUSION: Herein we review the literature regarding this unusual entity, and discuss the differential diagnosis, immunohistochemistry, and the importance of correctly identifying this rare tumor.

Prostatic nephrogenic adenoma. Case report.

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate. METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection. CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.

[Two cases of primary female urethral cancer].

Herein, we report two cases of female urethral cancer. Case 1 presented with acute urinary retention and case 2 presented with a painful perineal mass. Magnetic resonance imaging (MRI) revealed a urethral tumor in both cases. Histopathological examination of transperineal biopsy specimens from both patients suggested clear cell adenocarcinoma in case 1 and squamous cell carcinoma in case 2. Both cases underwent total urethrectomy with partial resection of the vaginal wall and cystostomy urinary diversion. With reference to case 1, obturator lymph node metastases were observed during surgery, and treatment comprised combined radiotherapy to 60 Gy and chemotherapy with 5-fluorouracil and cisplatin following surgery. However, metastases appeared in the lung 6 months after initial treatment and she died 20 months after surgery. For case 2, tumor marker failure was observed 5 months after surgery. The same combined treatment was performed and a complete response was obtained. At 19 months after surgery, the patient showed no evidence of recurrence.

Long-term follow-up of intravesical bacillus Calmette-Guérin treatment for superficial transitional-cell carcinoma of the bladder involving the prostatic urethra.

BACKGROUND: Intravesical bacillus Calmette-Guérin (BCG) is a treatment option for superficial (5-year follow-up. PATIENTS AND METHODS: Twenty-eight patients with high-risk superficial bladder cancer and prostatic urethral involvement were treated with once-weekly BCG for 6 weeks. Patients with prostatic stromal involvement were excluded. Maintenance was not used before 1995. Currently, we use maintenance BCG after induction. Patients were followed by cystoscopy/cytology and repeat biopsy to detect persistent and/or progressive disease. RESULTS: After 1 or 2 courses of once-weekly BCG for 6 weeks, 64.3% (18 of 28 of patients) exhibited a complete response in the bladder and prostate at their 6-month followup. Of those obtaining a complete response, 55.6% (10 of 18) experienced recurrence. Three recurrences were in the prostate: 1 isolated and 2 associated with multifocal bladder involvement. Twenty-eight percent (8 of 28 patients) underwent cystectomy because of failure of treatment to eradicate superficial disease or disease progression. Disease-specific survival was 89% (25 of 28 patients) at a median follow-up of 7.5 years. CONCLUSION: Our long-term data support the durability of intravesical BCG in select patients with superficial bladder transitional cell carcinoma with prostatic urethral involvement. Follow-up biopsy of the prostatic urethra is mandatory and, if positive, cystectomy is indicated. One third of patients will require cystectomy for persistent or progressive disease; therefore, careful surveillance is critical.

Papiloma invertido. Aportación de dos casos y revisión de la literatura / Inverted papilloma. Report of two cases and bibliographic review

Objetivo: El papiloma invertido es una rara lesión polipoidea del urotelio, conocida como entidad diferente desde 1963, desde cuando escasamente se han publicado más de 100 casos en la literatura. Aunque su potencial maligno es todavía desconocido, existen varias publicaciones científicas en las que se denota. Métodos: Presentamos dos casos de papiloma invertido y hacemos una detallada revisión de la literatura científica al respecto. Resultados: Ambos pacientes fueron diagnosticados por el servicio de Anatomía Patológica de papiloma invertido, siguiendo controles periódicos posteriores y no apareciendo recidivas en ninguno de los dos casos, a los 24 y 18 meses de seguimiento respectivamente. Conclusiones: La posibilidad de que el papiloma invertido sea una lesión con potencial maligno debe ser en todo caso considerada y sugerimos que los pacientes con este diagnóstico sean sometidos a los exámenes urológicos de seguimiento en cualquier neoplasia vesical (AU)

Objective: Inverted papilloma is a rare polypoid lesion of the urothelium, known as a different entity since 1963. Not many more than 100 cases have been published. Although its malignant potential is still unknown, several scientific publications have noted it. Methods: We report to cases of inverted papilloma and perform a detailed bibliographic review. Results: Both patients were diagnosed by the Pathology Department and entered periodic follow-up visits, being free of recurrence at 24 and 18 months respectively. Conclusions: The possibility that inverted papilloma is a lesion with malignant potential should be considered in every case, and we suggest that patients with this diagnosis should enter a follow-up protocol like any bladder neoplasia (AU)

Intravesical instillations with bacillus calmette-guérin for the treatment of carcinoma in situ involving prostatic ducts.

OBJECTIVES: Bacillus Calmette-Guérin (BCG) has proven its efficacy in the treatment of carcinoma in situ (CIS) of the prostatic urethra. We performed a retrospective study to evaluate the use of intravesical instillations of BCG in patients with carcinoma in situ involving prostatic ducts after complete transurethral resection (TUR). MATERIAL AND METHODS: Eligibility for the study was CIS of the prostatic urethra involving prostatic ducts. Previous instillation with BCG was an exclusion criterion. Patients were treated with intravesical BCG Connaught (81 mg) administered once a week, over a 6-wk period. TUR loop biopsies of the prostate were performed only when a macroscopic tumor was present. RESULTS: In this retrospective study of 11 patients, 8 (73%) presented with macroscopic tumor in the prostatic urethra. Ten patients (91%) had a simultaneous superficial bladder carcinoma. Eight patients (73%) had tumoral involvement of the bladder neck region. After a median follow-up of 27 mo (n=10 patients), the response in the prostatic urethra was 82%, and the response in the bladder due to superficial tumor recurrence was 64%. Two patients with residual ductal disease in the prostatic urethra were subsequently treated with cystoprostatectomy and are currently free of disease. In one of those patients, the cystoprostatectomy specimen did show prostatic stromal invasion. Another patient developed distant metastatic disease and died a few months after diagnosis. Thus, progression was encountered in two patients (18%). Currently, 90% of patients are alive without evidence of disease and 72.7% have benefitted from this bladder preservation strategy. CONCLUSION: Intravesical BCG is a feasible treatment option for patients with CIS involving prostatic ducts. In this retrospective study, bladder preservation was successful in 8 of 11 patients (70%) and there was only one oncologic death. Obviously, these patients need a careful follow-up with cystoscopy and cytology to detect either recurrence or progression and in those with persistent disease after the initial BCG induction therapy, prompt cystectomy is indicated.

Prolapso de uretra / Urethral prolapse

El prolapso uretral en la mujer es infrecuente. Se define como la completa eversión de la mucosa uretral a través del meato. Ocurre frecuentemente en mujeres negras prepúperes y en mujeres blancas posmenopáusicas. El tratamiento recomendado incluye desde la terapia conservadora hasta múltiples intervenciones quirúrgicas (AU)

Prolapse of the urethra in female patients is a rare events. It is defined as the complete eversion of the urethral mucosa through the external meatus. It occurs most often in pre-puberal black girls and in postmenopausal white women. Recommended treatment ranges from conservative therapy to a diversity of operative techniques (AU)

Ukrain in the treatment of urethral recurrent carcinoma (case report).

In a patient with low grade differentiated urethral carcinoma (histologically: urothelial carcinoma G2 and G3, pT1 with low grade differentiation) operation was carried out, with recurrence after two months. Instead of reoperation the patient was given Ukrain as monotherapy. No carcinoma was detected four months later by histological examination or during examinations three years later.

[Local anesthesia in CO2 laser treatment of disseminated therapy-resistant condylomata]. / Lokalanaestesi ved CO2-laserbehandling af udbredte terapiresistente kondylomer.

In an open prospective study 67 patients with refractory genital warts, irrespective of anatomic localization, received CO2-laser vaporization in local anaesthesia, using lidocaine 2% as the local anaesthetic. Sufficient anaesthesia was obtained in all treated patients, with minor pain as the only side effect observed. A single CO2-laser treatment resulted in disappearance of the lesions in 37 (55%) of the patients. Repeated CO2-laser vaporizations in patients with recurrent disease increased the cure rate to 85%. The response rate seemed unaffected by the localization of the warts. It is concluded, that local anaesthesia might replace general anaesthesia in the treatment of patients with multiple refractory genital warts.

Primary carcinoma of female urethra.

The clinical and morphologic features in 29 cases of primary carcinoma of the female urethra were reviewed. Only 2 of 12 patients treated with radiotherapy are known to have failed; one is dead of disease at one year, and the other is alive with local recurrence at two years. We consider these results sufficiently satisfactory to warrant the continued use of radiotherapy in early-stage lesions, as well as in selected patients who have infiltrating carcinoma. Integrated therapy consisting of 5,000 rad/25 fractions/five weeks, followed in six weeks by radical cystourethrectomy, was used in 7 patients. The low morbidity and absence of operative mortality recommend continuation of this aggressive approach for infiltrating tumors in selected patients.

Sex therapy and penectomy.

A 65-year-old man, having undergone a penectomy operation that spared the ejaculatory apparatus and some erotically responsive areas, experienced a spontaneous orgasm, with ejaculation, upon being touched in the perineal area during a massage. Unable to duplicate the experience, he (and later his wife) entered sex therapy, which resulted in his being able to have orgasms during lovemaking. The course of the therapy is described, as are certain issues arising from the therapy. Regaining of the man's orgasmic ability was accompanied by a striking improvement in the intrapsychic and interpersonal functioning of the couple, and this is taken to be an example of the "ripple effect" of successful sex therapy. The implications for this therapeutic approach for the rehabilitation of other penectomy patients and their spouses are discussed. Finally the question of surgical penile reconstruction in such cases is explored.