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Benign smooth muscle tumors of the female urethra are rare. A case of urethral leiomyoma which had been present for 18 years before surgical removal is reported. The pathogenesis and the clinical aspects of this unusual clinical condition are discussed. Prof. Cesare Selli, Clinica Urologica, Viale Pieraccini 18, I-50139 Florence (Italy) Introduction Leiomyomas of the female genital tract are common benign neoplasms, but their localization in the urinary tract is quite exceptional, being found mostly in the kidney [1]. Leiomyomas of the female urethra are exceedingly unusual, and a comprehensive recent review collected a total of 36 cases in the world literature [2]. Paraurethral leiomyomas, which arise from contiguous structures belonging to the genital tract such as the anterior vaginal wall or the vesicovaginal septum, must be distinguished from true primary urethral localizations [3]. A case of leiomyoma of the female urethra which had been present for 18 years before surgical removal is described. D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /6 /2 01 7 2: 05 :1 3 A M Fig. 1. A Preoperative aspect of the leiomyoma arising from the upper contour of the urethral meatus. B Pathologic specimen. Case Report A 46-year-old woman, gravida II para 2, was referred by her gynecologist for evaluation of a mass arising from the superior contour of the external urethral meatus. The mass measured 3 × 2.5 cm, it was ovoid in shape, had a firm consistency and was covered by hyperemic mucosa (fig. 1). The patient reported no subjective symptoms and failed to recall any dyspareunia. The mass which had been noted 18 years before on occasion of her second delivery had progressively increased in size. Physical examination was otherwise normal, blood chemistries were within normal limits, and the posterior urethra and bladder were normal at cystourethroscopy. At surgery a Foley catheter was inserted, the tumor was excised and a meatoplasty was performed using 3-0 chromic catgut interrupted sutures. Convalescence was uneventful and the patient has been followed for 1 year without local recurrence. Histopathology revealed a benign tumor composed of spindle cells arranged in whorls and interlacing fascicles without nuclear aty-pia or mitoses (fig. 2). In order to characterize the nature of the lesion, immunohistochemical studies were carried out. ABC peroxi-dase technique revealed marked and diffuse cytoplasmic positivity for alpha smooth muscle actin and desmin (fig. 3), scant staining for vimentin and negative staining for S-100 protein. These findings were consistent with the diagnosis of benign leiomyoma. © 1995 S.KargerAG, Basel 0042-1138/95/0543-0179 $8.00/0 1⁄8·”;. Fig. 2. Microphotography: smooth muscle cells are disposed in interlacing fascicles and whorls, blending with fibrous stroma. There is lack of nuclear atypia and mitotic figures. HE. × 100. Fig. 3. Microphotography: immunohistochemical study with ABC technique using a monoclonal antibody anti-alpha smooth muscle actin. There is diffuse cytoplasmic staining of all leiomyoma cells. ×250. Discussion Lesions of the female urethra are benign in about 95% of the cases, since a pathologic review of 394 excised masses revealed only 22 malignant tumors [4]. Urethral caruncles are by far the most common lesions, but differential diagnosis encompasses a wide array of conditions which include urethral diverticulum, mucosal prolapse, ectopic ureterocele, Gartner’s duct cyst, congenital vaginal cyst, fibrous polyp, squamous carcinoma of the urethra and mesenchymal tumors (e.g. neurofibroma). Leiomyomas of the urethra have been diagnosed in patients with an average age of 39.8 years. They are firm and painless masses which usually measure < 1 cm in diameter, but they have been known to reach occasionally a much larger size [3]. Even though their etiology is still unknown, some correlation with pregnancy has been reported, in parallel with the more common uterine D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /6 /2 01 7 2: 05 :1 3 A M leiomyomas, which can also be associated [5, 6]. Therefore, some hormonal sensitivity may beinvolved, as eviden-tiated also by the present case.Some leiomyomas of the female urethra can be asymptomatic, and a review of the clinicalpresentation on 29 cases is showed in table 1. Surgical treatment is generally simple andstraightforward, and a meatoplasty is advisable after the removal of larger lesions.Local recurrence has been documented in only 2 cases [7,8], while no malignant degenerationhas been reported. From a histopathologic point of view, these lesions are quite similar to uterineleiomyomas, and immunohistochemical studies may be useful in determining the origin fromsmooth muscle cells. Table 1. Presenting symptoms of leiomyomas of the female urethra (n = 29)PatientsPresenting symptomsVaginal mass 17 58Urinary tract infection 14 48Dyspareunia 7 24Bladder outflow obstruction 4 13Stress incontinence 2 6Hematuria 2 6From Cheng et al. [2], with the addition of the present case.ReferencesSelli C, Masi A, Vanni L, Ricupero M, Beccari P, Lapini A, Santucci M, Amorosi A: Conflictingradiological aspects of renal leiomyoma with different imaging techniques. Urol Int1992;48:219-222.Cheng C, Mac-Moune Lai F, Chan PSF: Leiomyoma of the female urethra: A case report andreview. J Urol 1992;148:1526-1527. Di Cello V, Saltutti C, Mincione GP, Rovereto B, Natali A,Durval A: Paraurethral leiomyoma in women. Eur Urol 1988;15:290-293. Marshall FC, Uson AC, Melicow MM: Neoplasms and caruncles of the female urethra.SurgGynecolObstet 1960;110:727-732.Shield DE, Weiss RM: Leiomyoma of the female urethra. J Urol 1973;109:430-432.Fry M, Wheeler JS Jr, Mata JA, Culkin DJ, St Martin E, Venable DD: Leiomyoma of the femaleurethra. J Urol 1988;140:613-614.Lake MH, Kossow AS, Bokinsky G: Leiomyoma of the bladder and urethra. J Urol 1981;125:742-743.Williams JL: Leiomyoma of the female urethra. Eur Urol 1979;5:144-145. 180Selli/DalCanto/Campani/Bartoletti/ De BenedettoLeiomyoma of the Female Urethra Downloadedby: 54.70.40.11-10/6/20172:05:13AM