Clear cell adenocarcinoma in a diverticulum of the female urethra. A case report and literature review

Abstract

Clinical case description: A 64-year-old woman with an unremarkable past medical history was evaluated due to lower urinary tract symptoms and hematuria of 1-month progression. A magnetic resonance imaging scan revealed a lesion consistent with urethral tumor. During urethrocystoscopy, a tumor was found inside a urethral diverticulum. Transurethral resection was carried out, followed by the later performance of anterior pelvic exenteration. The histopathologic result was clear cell adenocarcinoma inside a proximal urethral diverticulum.  The patient did not undergo adjuvant therapy, remaining in follow-up and surveillance, and is presently recurrence-free.

Relevance: Urethral carcinoma is an uncommon tumor and its appearance in a diverticulum is rare. Those types of tumor are highly invasive and require aggressive treatment to offer the possibility of cure.

Clinical implications: No standardized treatment is in place. Surgical treatment through radical urethrectomy or anterior pelvic exenteration, with or without adjuvant therapy, is the most widely accepted therapeutic option.

Conclusions: Clear cell adenocarcinoma arising in a urethral diverticulum is uncommon and usually has a locally advanced presentation. There is no standardized treatment or follow-up for the disease.