Walsh Emily, Kelly Niall, Daly Padraig, Shah Nigam, Cullen Ivor
Department of Urology, Department of Surgery, University Hospital Waterford, Waterford, Ireland.
Department of Histopathology, University Hospital Waterford, Waterford, Ireland.
J Med Case Rep. 2021 Feb 19;15(1):91. doi: 10.1186/s13256-020-02553-z.
Primary urethral carcinoma (PUC) is rare and accounts for < 1% of all genito-urinary cancers. There is a male predominance of 3:1 and a peak incidence in the 7th and 8th decades. The aetiology of this cancer is similar to penile cancer, and the human papilloma virus (HPV) is thought to be an essential factor in tumorigenesis. Urethral cancer should be diagnosed and staged with a combination of tumour biopsy, MRI, and CT with treatment involving a multimodal approach. Contemporary management emphasises phallus-preserving surgery where feasible.
Here, we describe a case of distal urethral carcinoma, which presented as a metastatic groin mass and identifying the primary lesion proved challenging. Diagnostic flexible cystoscopy identified a tiny lesion in the navicular fossa, which was biopsied and confirmed to be a squamous cell carcinoma. The patient then underwent phallus preserving surgery, including distal urethrectomy with bilateral inguinal lymph node dissections. The final stage was pT1N1M0, and adjuvant chemotherapy was started. The distal urethrectomy involved the surgical creation of a hypospadic meatus in the midshaft of the penis. Normal voiding and sexual function were preserved.
Urethral cancer is a rare malignancy and clinicians should bear in mind that early diagnosis of this disease can be very difficult depending on the anatomical location of the tumour. Treatment currently favours penis-preserving surgery.
原发性尿道癌(PUC)较为罕见,占所有泌尿生殖系统癌症的比例不到1%。男性发病率是女性的3倍,发病高峰在70至80岁。这种癌症的病因与阴茎癌相似,人乳头瘤病毒(HPV)被认为是肿瘤发生的一个重要因素。尿道癌的诊断和分期需要结合肿瘤活检、MRI和CT,治疗采用多模式方法。当代治疗方法在可行的情况下强调保留阴茎的手术。
在此,我们描述一例远端尿道癌病例,该病例表现为腹股沟转移性肿块,确定原发灶颇具挑战性。诊断性软性膀胱镜检查在舟状窝发现一个微小病变,经活检证实为鳞状细胞癌。患者随后接受了保留阴茎的手术,包括远端尿道切除术及双侧腹股沟淋巴结清扫术。最终分期为pT1N1M0,随后开始辅助化疗。远端尿道切除术包括在阴茎中段手术造一个尿道下裂尿道口。患者排尿和性功能均得以保留。
尿道癌是一种罕见的恶性肿瘤,临床医生应牢记,根据肿瘤的解剖位置,该病的早期诊断可能非常困难。目前的治疗倾向于保留阴茎的手术。