Female Distal Urethral Primary Urothelial Carcinoma: Rare Entity and Management

Abstract

Urethral malignancies as such are rare among urological cancers. Female distal urethral cancers are predominantly squamous cell carcinoma. Urothelial cancer mainly arises from proximal urethra and is associated with carcinoma of upper tract. A 63-year-old lady presented with hematuria and voiding lower urinary tract symptoms. On pelvic examination, ~ 3-cm hard mass was palpable in distal urethra involving anterior vaginal wall. Biopsy revealed transitional cell carcinoma. Metastatic workup was negative. Patient underwent robot-assisted laparoscopic radical cystourethrectomy (anterior exenteration) with bilateral standard pelvic LN dissection and intracorporeal ileal conduit urinary diversion. Postoperative course was uneventful. Histopathology of the specimen revealed high-grade urothelial cancer of distal urethra (pT3N0M0). At 3 months, patient presented with a solitary right inguinal lymph node, reported as malignant on fine needle aspiration cytology. Patient received 6 cycles of adjuvant chemotherapy and radiotherapy to groin and presently well at 2-year follow-up without recurrence. Distal urethral cancer is rarely of urothelial origin. These are aggressive tumors, and adequate treatment and follow-up is required for better oncological outcome.