title: Urethral carcinoma in situ: recognition and management.
abstract: OBJECTIVE
  Urethral carcinoma in situ (CIS) is an uncommon malignancy that is poorly described in the published literature and is often under-recognized in the clinical setting. This short case series reports some challenges associated with the recognition and management of this disease.
  
  
  METHODS
  A retrospective chart review was done over a 12-year period of patients presenting with urethral cancer to the Johns Hopkins Hospital. Four patients were identified with CIS of the anterior urethra, and their demographic and clinical data were recorded.
  
  
  RESULTS
  Three patients presented with meatal lesions that were initially treated as infectious/inflammatory diseases before diagnoses of malignancy were determined following lesion biopsy. The fourth patient presented with painless hematuria and had a cystoscopy and biopsy of urethral polyps. All patients were treated surgically by sequential distal urethrectomy and various reconstructive procedures. Concurrent lymph node dissections were undertaken in two patients who had clinical or radiologic evidence of lymphadenopathy. One patient had persistent disease even after aggressive urethral resection, and he succumbed to his illness 2 years later.
  
  
  CONCLUSIONS
  This is the largest series of urethral CIS, a disease with potentially serious consequences. A high index of suspicion should be maintained when evaluating and managing these patients.
authors.affiliation: Division of Urology, Hospital das Clinicas, University of Sao Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ricardo H
authors.initials: RH
authors.lastname: Berjeaut
authors.affiliation: Department of Urology, San Fernando General Hospital, University of the West Indies (UWI) School of Medicine, San Fernando, Trinidad and Tobago.
authors.forename: Maliza D I
authors.initials: MD
authors.lastname: Persaud
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Sopko
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. aburnet1@jhmi.edu.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
mesh_terms: D000368:Aged; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D003951:Diagnostic Errors; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D014523:Urethral Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
keywords: Anterior urethra; Carcinoma in situ; Human papilloma virus; Squamous cell carcinoma