Advanced female urethral adenocarcinoma: A case report

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Urethral cancer in females is rare, with squamous cell carcinoma being most common and adenocarcinoma least common.
• The cell of origin for female urethral adenocarcinoma remains unclear, with prior theories suggesting skene gland origin.
• Adenocarcinoma of the female urethra is an uncommon malignancy presenting diagnostic and therapeutic challenges.

Purpose of the Study:

• To report a rare case of prostate-specific antigen (PSA) negative adenocarcinoma of the female urethra.
• To describe the diagnostic workup, including imaging and biopsy findings.
• To outline the multimodal treatment approach and final pathological outcome.

Main Methods:

• Case presentation of a 58-year-old female with lower urinary tract symptoms.
• Diagnostic evaluation included cystoscopy, biopsy, and positron emission tomography-computed tomography (PET-CT).
• Treatment involved neoadjuvant chemotherapy, anterior exenteration, pelvic lymphadenectomy, and ileal conduit urinary diversion.

Main Results:

• Biopsy revealed PSA-negative adenocarcinoma.
• PET-CT demonstrated pelvic and inguinal nodal metastasis.
• Final histology confirmed ypT4 yN1 adenocarcinoma, not otherwise specified, after neoadjuvant therapy.

Conclusions:

• This case underscores the rarity and complexity of female urethral adenocarcinoma.
• Multimodal therapy, including neoadjuvant chemotherapy and radical surgery, can be considered for advanced disease.
• Further research is needed to elucidate the cell of origin and optimize treatment strategies for this rare cancer.