Shields Lisa B E, Kalebasty Arash Rezazadeh
Norton Neuroscience Institute, Norton Healthcare, Louisville, KY 40202, United States.
Norton Cancer Institute, Norton Healthcare, Louisville, KY 40202, United States.
World J Clin Oncol. 2020 Apr 24;11(4):243-249. doi: 10.5306/wjco.v11.i4.243.
Clear cell adenocarcinoma of the urethra is a rare type of aggressive cancer with a poor prognosis. Clear cell carcinoma of the urethra represents less than 0.02% of all malignancies in women. Adenocarcinomas account for 10% of female urethral carcinomas, of which 40% are the clear cell variant. Determining the presence or absence of certain mutations through genetic testing may predict whether a patient with cancer may benefit from a particular chemotherapy regimen.
A 40-year-old woman presented with a 3-year history of slow urinary flow and a 3-mo history of urinary urgency and frequency as well as gross hematuria. An abdominal and pelvic computed tomography scan demonstrated enlarged lymph nodes in the abdomen and pelvis. A biopsy of a left inguinal lymph node microscopically confirmed a metastatic adenocarcinoma of the urethra. Specialized genetic testing determined personalized chemotherapy. She was treated successfully with a non-platinum-based chemotherapy consisting of paclitaxel and bevacizumab. Following 3 cycles of paclitaxel and bevacizumab, she attained significant clinical improvement, and response by FDG-Positron emission tomography (PET) imaging showed a definite improvement in size and metabolic activity. She achieved complete response after 6 cycles of therapy by PET scan. The patient concluded 11 cycles of paclitaxel and bevacizumab, and a subsequent PET scan confirmed progression of metastatic disease. The patient was then treated with two cycles of doxorubicin after which a PET scan revealed a mixed response to the treatment.
We report the first case of a patient with metastatic clear cell adenocarcinoma of the urethra who underwent personalized chemotherapy after testing for cancer gene alterations. Our unique case represents the safe and effective use of non-platinum-based chemotherapy in clear cell adenocarcinoma of the urethra.
尿道透明细胞腺癌是一种罕见的侵袭性癌症，预后较差。尿道透明细胞癌在女性所有恶性肿瘤中占比不到0.02%。腺癌占女性尿道癌的10%，其中40%为透明细胞变体。通过基因检测确定某些突变的有无，可能预测癌症患者是否能从特定化疗方案中获益。
一名40岁女性，有3年排尿缓慢病史，3个月尿急、尿频及肉眼血尿病史。腹部和盆腔计算机断层扫描显示腹部和盆腔淋巴结肿大。左侧腹股沟淋巴结活检在显微镜下确诊为尿道转移性腺癌。专门的基因检测确定了个性化化疗方案。她接受了由紫杉醇和贝伐单抗组成的非铂类化疗并获得成功。在接受3个周期的紫杉醇和贝伐单抗治疗后，她取得了显著的临床改善，氟脱氧葡萄糖正电子发射断层扫描（PET）成像显示肿瘤大小和代谢活性有明显改善。经过6个周期的治疗，PET扫描显示她达到了完全缓解。该患者完成了11个周期的紫杉醇和贝伐单抗治疗，随后的PET扫描证实转移性疾病进展。然后该患者接受了两个周期的阿霉素治疗，之后PET扫描显示对治疗有混合反应。
我们报告了首例尿道转移性透明细胞腺癌患者在进行癌症基因改变检测后接受个性化化疗的病例。我们的独特病例代表了非铂类化疗在尿道透明细胞腺癌中的安全有效应用。
