title: Urethral Metastasis from Rectal Adenocarcinoma: A Case Report and Review of the Literature.
abstract: METHODS
  A 73-year-old man with Dukes' C adenocarcinoma of the rectum, pT3N2bM0, stage IIIB, presented with voiding difficulties including poor stream and terminal dribbling for one month. The patient was under careful surveillance and had no postoperative recurrence. Physical examination revealed a palpable irregular nodular lesion (0.5 × 0.5 cm(2)) at the penile-scrotal junction. He underwent urethroscopy, which showed a cauliflower lesion in the pendulous urethra. Transurethral resection was performed and histopathologic and immunochemical staining demonstrated a metastatic moderately differentiated urethral adenocarcinoma from the colorectal primary.
  
  
  RESULTS
  His voiding disorder improved significantly post-operation and he commenced second-line chemotherapy combined with regional radiotherapy. Follow-up urethrocystoscopy and abdominal computed tomography demonstrated no recurrence or metastatic disease. His tumor marker remained within the normal range for 12 months.
  
  
  CONCLUSIONS
  Urethral metastasis from primary colon cancer is extremely rare. This disease, with its various atypical presentations, presents a diagnostic challenge to the clinician. In patients with recurrent or persistent lower urinary tract symptoms, further urologic workup including thorough history taking, physical examination, and imaging surveys is warranted.
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Chun-Feng
authors.initials: CF
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Shun-Neng
authors.initials: SN
authors.lastname: Hsu
authors.affiliation: Department of Pathology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Shang-Tao
authors.initials: ST
authors.lastname: Chien
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Chian-Ting
authors.initials: CT
authors.lastname: Wang
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Ying-Jui
authors.initials: YJ
authors.lastname: Ni
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Ching-Wen
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Division of Urology, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
authors.forename: Jian-Tai
authors.initials: JT
authors.lastname: Mei
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery / Q000628:therapy; D000368:Aged; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000473:pathology*; D014523:Urethral Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy
keywords: adenocarcinoma; metastasis; rectum; urethra