Primary Clear Cell Adenocarcinoma in a Female Urethral Diverticulum: A Case Report and Review

Abstract

Clear Cell Adenocarcinoma is a very rare variant of lower urinary tract malignancy. We present a 54 years old lady who presented with haematuria and a urethral mass on ultrasound. MRI subsequently demonstrated a heterogeneous mass within a urethral diverticulum. Biopsies of the mass demonstrated clear cell adenocarcinoma with clearing of the cytoplasm, moderate nuclear pleomorphism. Immunohistochemically cells were positive for: cytokeratin 7 and p16, p53, CA125, CAM5.2, AE1/AE3. They were negative for: thrombomodulin, oestrogen, progesterone, cytokeratin 20, p63, CD10, CEAP, WT1, AFP, s100. She underwent anterior exenteration with pelvic lymphadenectomy, and ileal conduit formation. Histology of which demonstrated surgically clear margins but 3/6 positive lymph nodes. She underwent 50.4Gy for consolidative radiotherapy given the lack of known benefit for chemotherapy. Subsequent PET scans have demonstrated lymphatic disease progression, but remains alive one year after diagnosis.




doi: http://dx.doi.org/10.4021/wjnu67w