Abstract
Purpose
Urethral carcinoma in situ (CIS) is an uncommon malignancy that is poorly described in the published literature and is often under-recognized in the clinical setting. This short case series reports some challenges associated with the recognition and management of this disease.
Methods
A retrospective chart review was done over a 12-year period of patients presenting with urethral cancer to the Johns Hopkins Hospital. Four patients were identified with CIS of the anterior urethra, and their demographic and clinical data were recorded.
Results
Three patients presented with meatal lesions that were initially treated as infectious/inflammatory diseases before diagnoses of malignancy were determined following lesion biopsy. The fourth patient presented with painless hematuria and had a cystoscopy and biopsy of urethral polyps. All patients were treated surgically by sequential distal urethrectomy and various reconstructive procedures. Concurrent lymph node dissections were undertaken in two patients who had clinical or radiologic evidence of lymphadenopathy. One patient had persistent disease even after aggressive urethral resection, and he succumbed to his illness 2 years later.
Conclusion
This is the largest series of urethral CIS, a disease with potentially serious consequences. A high index of suspicion should be maintained when evaluating and managing these patients.
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References
Swartz MA, Porter MP, Lin DW, Weiss NS (2006) Incidence of primary urethral carcinoma in the United States. Urology 68(6):1164–1168
Dayyani F, Hoffman K, Eiffel P, Guo C, Vikram R, Pagliaro LC et al (2014) Management of advanced primary urethral carcinomas. BJU Int 114(1):25–31
Kim SJ, Maclennan GT (2005) Tumors of the male urethra. J Urol 174(1):312
Gakis G, Witjes JA, Comperat E, Cowan NC, DeSantis M, Lebret T et al (2013) EAU Guidelines on primary urethral carcinoma. Eur Urol 64(5):823–830
Velazquez EF, Soskin A, Bock A, Codas R, Cai G, Baretto JE et al (2005) Epithelial abnormalities and precancerous lesions of the anterior urethra in patients with penile carcinoma: a report of 89 cases. Mod Pathol 18(7):917–923
Chaux A, Han JS, Lee S, Gonzalez-Roibon N, Sharma R, Burnett AL et al (2013) Immunohistochemical profile of the penile urethra and differential expression of GATA3 in urothelial versus squamous cell carcinomas of the penile urethra. Hum Pathol 44(12):2760–2767
Althahausen AF, Prout GRJ, Daly JJ (1976) Non-invasive papillary carcinoma of the bladder associated with carcinoma in situ. J Urol 116(5):575–580
Chade DC, Shariat SF, Godoy G, Savage CJ, Cronin AM, Bochner BH et al (2010) Clinical outcomes of primary bladder carcinoma in situ in a contemporary series. J Urol 184(1):74–80
Sylvester RJ, van der Meijden A, Witjes JA, Jakse G, Nonomura N, Cheng C et al (2005) High-grade Ta urothelial carcinoma and carcinoma in situ of the bladder. Urology 66(6):90–107
Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BWG, Comperat E et al (2013) EAU Guidelines on non-muscle invasive urothelial carcinoma of the bladder: update 13. Eur Urol 64(4):639–653
Pedrosa JA, Amstutz SP, Bihrle R, Mellon MJ (2014) Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra: an updated series. Int Urol Nephrol 46(8):1551–1555
Smith Y, Hadway P, Ahmed S, Perry MJ, Corbishley CM, Watkin NA (2007) Penile-preserving surgery for male distal urethral carcinoma. BJU Int 100(1):82–87
Burnett AL (2016) Penile preserving and reconstructive surgery in the management of penile cancer. Nat Rev Urol 13(5):249–257
Dalbagni G, Zhang ZF, Lacombe L, Herr HW (1999) Male urethral carcinoma: analysis of treatment outcome. Urology 53(6):1126–1132
Weiner JS, Liu ET, Walther PJ (1992) Oncogenic human papillomavirus type-16 is associated with squamous cell cancer of the male urethra. Cancer Res 52:5018–5023
Cupp MR, Malek RS, Goellner JR, Espy MJ, Smith TF (1996) Detection of human papillomavirus DNA in primary squamous cell carcinoma of the male urethra. Urology 48(4):551–555
Dinney CPN, Johnson DE, Swanson DA, Babaian RJ, Von Eschenbach AC (1994) Therapy and prognosis for male anterior urethral carcinoma: an update. Urology 43(4):506–514
Hopkins SC, Nag SK, Soloway MS (1984) Primary carcinoma of the male urethra. Urology 23(2):128–133
Karnes RJ, Breau RH, Lightner DJ (2010) Surgery for urethral cancer. Urol Clin North Am 37(3):445–457
Eng TY, Naguib M, Galang T, Fuller CD (2003) Retrospective study of the treatment of urethral cancer. Am J Clin Oncol 26(6):558–562
Gheiler EL, Tefilli MV, Tiguert R, De Oliveira JG, Pontes JE, Wood DP (1998) Management of primary urethral cancer. Urology 52(3):487–493
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Berjeaut, R.H., Persaud, M.D.I., Sopko, N. et al. Urethral carcinoma in situ: recognition and management. Int Urol Nephrol 49, 637–641 (2017). https://doi.org/10.1007/s11255-017-1512-3
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DOI: https://doi.org/10.1007/s11255-017-1512-3