title: [Primary adenocarcinoma of the female urethra treated by multimodal therapy].
abstract: A 64-year old female presented with urinary retention. Physical examination revealed a firm mass on the anterior vaginal wall. Magnetic resonance imaging showed a tumor surrounding the urethra, which invaded to the vesical triangle and the anterior vaginal wall. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated, but squamous cell carcinoma antigen and prostate specific antigen were within normal limits. Pathological examinations of the transurethral and transvaginal needle biopsy specimen suggested mucinous adenocarcinoma. First, the patient received local chemoradiotherapy and systemic chemotherapy using a fluoropyrimidine drug TS-1 and cisplatin. The tumor markers declined to within normal limits after this preoperative therapy. Then she underwent total cysto-urethrectomy with anterior vaginal wall resection, pelvic lymphadenectomy, and urinary diversion with ureterocutaneous fistula. Histopathological examination of the surgical specimen showed mutinous adenocarcinoma invading to the vesical triangle and the anterior vaginal wall. No metastasis was found in the lymph nodes. The final diagnosis was urethral adenocarcinoma, pT4N0, Stage IV. Five months after surgery, local recurrence and distant metastases appeared, and she died 14 months after surgery.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Hajime
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Komai
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Aki
authors.initials: A
authors.lastname: Iwai
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sakai
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawakami
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D014523:Urethral Neoplasms / Q000473:pathology / Q000628:therapy*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy; D014625:Vaginal Neoplasms / Q000473:pathology / Q000628:therapy