Berjeaut Ricardo H, Persaud Maliza D I, Sopko Nikolai, Burnett Arthur L
Division of Urology, Hospital das Clinicas, University of Sao Paulo School of Medicine, São Paulo, Brazil.
Department of Urology, San Fernando General Hospital, University of the West Indies (UWI) School of Medicine, San Fernando, Trinidad and Tobago.
Int Urol Nephrol. 2017 Apr;49(4):637-641. doi: 10.1007/s11255-017-1512-3. Epub 2017 Jan 18.
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.
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.
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.
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.
原位尿道癌（CIS）是一种罕见的恶性肿瘤，在已发表的文献中描述较少，在临床环境中常未被充分认识。本短篇病例系列报告了与该疾病的识别和管理相关的一些挑战。
对约翰霍普金斯医院12年间就诊的尿道癌患者进行回顾性病历审查。确定了4例前尿道原位癌患者，并记录了他们的人口统计学和临床数据。
3例患者表现为尿道口病变，最初被当作感染性/炎症性疾病治疗，在病变活检后确诊为恶性肿瘤。第4例患者表现为无痛性血尿，接受了膀胱镜检查和尿道息肉活检。所有患者均接受了序贯性远端尿道切除术及各种重建手术。2例有临床或影像学证据显示淋巴结肿大的患者同时进行了淋巴结清扫术。1例患者即使在积极的尿道切除术后仍有持续性疾病，2年后因病死亡。
这是最大系列的尿道原位癌病例，该疾病可能会产生严重后果。在评估和管理这些患者时应保持高度的怀疑指数。
