Microsoft Word - GOI279BF

Urethra Secondary cancer Urethral caruncle Abstract Secondary female urethral cancer presenting as urethral caruncle is extremely rare. We report a primary ovarian adenocarcinoma in a 78-year-old female patient presented initially as a urethral caruncle. This case represents the first reported case in the world literature. The clinical features, investigations and pertinent literature are reviewed. M.Y. Hammadeh, Registrar in Urology, Whipps Cross Hospital, Leytonstone, London E11 1NR (UK) Fig. 1. Urethral caruncle with adenocarcinoma (C) and normal urethral epithelium (U). HE. × 200. the left. This mass could not be seen separately from the uterus. Lapa-rotomy showed the presence of an irregular left ovarian mass which was fixed to the pelvic side wall. The right ovary, Fallopian tubes, liver and omentum were normal. Hysterectomy and salpingooophorectomy was impossible because of tumour fixation. Multiple biopsies from the tumour were taken. The histopathology revealed ovarian adenocarcinoma with similar morphology to the ‘urethral caruncle’ (fig. 2). The patient was referred for palliative chemotherapy. Introduction Primary female urethral cancers are relatively rare: to date, approximately 1,200 such cases have been reported [1]. The association of primary urethral tumour and caruncles have been reported in 9 of 376 patients who presented with urethral caruncles [2]. Secondary female cancer is uncommon: of 73 urethral tumours, Roberts and Melicow [3] reported 3 secondary tumours. We report an ovarian adenocarcinoma in a female patient who presented originally with a clinical urethral caruncle. Case Report A 78-year-old female presented with urethral bleeding and difficulty in passing urine. Clinical examination showed a large urethral caruncle which was excised. The subsequent histopathology revealed a well-differentiated adenocarcinoma (fig. 1). Intravenous pyelogram and urine cytology were normal. Examination under anaesthesia revealed the presence of a pelvic mass but no urethral thickening, and cystourethroscopy showed a normal urethra and