CASE REPORTS
CARCINOMA PITFALLS
MARTIN
IN SITU IN URETHRAL
OF MARSUPIALIZATION
G. McLOUGHLIN,
M.D.,
F.R.C.S.
DIVERTICt’liI’Y
:
ALONE
(C)
From the James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
ABSTRACT - Carcinoma in situ was found in a urethral dive&x.&m in a fifty-one-year-old black woman. The discovery of this lesion lends support to the fact that biopsy of the urethral diverticulum should be performed even if a Spence-Duckett procedure is carried out. _
A variety of procedures have been described for the management of urethral diverticula in women1 Because many of these procedures are complicated by urethral stenosis, urethral vaginal fistula, and abscess formation, Spence and Duckett2 have recently described an ingenious technique in which urethra is incised in the midline down to the ostium of the diverticulum and the walls of the diverticulum and distal urethra are marsupialized to the vaginal mucosa. They do not mention the importance of excising the wall of the diverticulum for pathologic examination. The following case history stresses the importance of excisional biopsy. Case Report A fifty-one-year-old black female with a history of urinary tract infection was seen at this clinic. Voiding cystourethrogram demonstrated a urethral diverticulum in the midportion of the urethra which was confirmed by cystoscopy. Transvaginal excision of the diverticulum was carried out with the patient in the lithotomy position. Although grossly the urethral mucosa appeared normal, pathologic examination of the specimen demonstrated in situ transitional cell carcinoma with tumor extending to the margins of the specimen. The patient was returned to the operating room, and repeat biopsies demonstrated carcinoma in situ in the entire urethra extending into the trigone. Consequently, a radical cystectomy and pelvic lymphadenectomy were carried out
UROLOGY /
SEPTEMBER 1975 /
VOLUME VI, NUMBER 3
with an ileal loop urinary diversion. Postoperatively the patient has been followed up for one year, has done well, is asymptomatic, and has stable renal function. Comment Development of carcinoma in a urethral diverticulum has been well documented and occasionally presents as an occult disease as in the case reported herein. 3-5 For this reason it is important that in the surgical management of urethral diverticula in women, the procedure should be carried out in such a manner that total inspection of the entire urethra can be performed. When using the Spence-Duckett marsupialization procedure, the diverticulum should be carefully examined and tissue removed for pathologic examination. Baltimore, Maryland 21205 References 1. DAVIS, B. L., and ROBINSON,D. G.: Diverticula of the female urethra: assay of 120 cases, J. Ural. 104: 850 (1970). 2. SPENCE, H. M., and DUCKETT, J. W. : Diverticulum of the female urethra: clinical aspects and presentation of a simple technique for cure, ibid. 104: 432 (1970). 3. DESAI, S., LIBERTINO, J. A., and ZINMAN,L.: Primary carcinoma of the female urethra, ibid. 110:693 (1973). 4. POINTON, R. C. S., and POOLE-WILSON, D. S.: Primary carcinoma ofthe urethra, Br. J. Urol. 40: 682 (1968). 5. GRABSTALD, H. : Tumors of the urethra in men and women, Cancer 32: 1236 (1973).
343
CARCINOMA PITFALLS
MARTIN
IN SITU IN URETHRAL
OF MARSUPIALIZATION
G. McLOUGHLIN,
M.D.,
F.R.C.S.
DIVERTICt’liI’Y
:
ALONE
(C)
From the James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
ABSTRACT - Carcinoma in situ was found in a urethral dive&x.&m in a fifty-one-year-old black woman. The discovery of this lesion lends support to the fact that biopsy of the urethral diverticulum should be performed even if a Spence-Duckett procedure is carried out. _
A variety of procedures have been described for the management of urethral diverticula in women1 Because many of these procedures are complicated by urethral stenosis, urethral vaginal fistula, and abscess formation, Spence and Duckett2 have recently described an ingenious technique in which urethra is incised in the midline down to the ostium of the diverticulum and the walls of the diverticulum and distal urethra are marsupialized to the vaginal mucosa. They do not mention the importance of excising the wall of the diverticulum for pathologic examination. The following case history stresses the importance of excisional biopsy. Case Report A fifty-one-year-old black female with a history of urinary tract infection was seen at this clinic. Voiding cystourethrogram demonstrated a urethral diverticulum in the midportion of the urethra which was confirmed by cystoscopy. Transvaginal excision of the diverticulum was carried out with the patient in the lithotomy position. Although grossly the urethral mucosa appeared normal, pathologic examination of the specimen demonstrated in situ transitional cell carcinoma with tumor extending to the margins of the specimen. The patient was returned to the operating room, and repeat biopsies demonstrated carcinoma in situ in the entire urethra extending into the trigone. Consequently, a radical cystectomy and pelvic lymphadenectomy were carried out
UROLOGY /
SEPTEMBER 1975 /
VOLUME VI, NUMBER 3
with an ileal loop urinary diversion. Postoperatively the patient has been followed up for one year, has done well, is asymptomatic, and has stable renal function. Comment Development of carcinoma in a urethral diverticulum has been well documented and occasionally presents as an occult disease as in the case reported herein. 3-5 For this reason it is important that in the surgical management of urethral diverticula in women, the procedure should be carried out in such a manner that total inspection of the entire urethra can be performed. When using the Spence-Duckett marsupialization procedure, the diverticulum should be carefully examined and tissue removed for pathologic examination. Baltimore, Maryland 21205 References 1. DAVIS, B. L., and ROBINSON,D. G.: Diverticula of the female urethra: assay of 120 cases, J. Ural. 104: 850 (1970). 2. SPENCE, H. M., and DUCKETT, J. W. : Diverticulum of the female urethra: clinical aspects and presentation of a simple technique for cure, ibid. 104: 432 (1970). 3. DESAI, S., LIBERTINO, J. A., and ZINMAN,L.: Primary carcinoma of the female urethra, ibid. 110:693 (1973). 4. POINTON, R. C. S., and POOLE-WILSON, D. S.: Primary carcinoma ofthe urethra, Br. J. Urol. 40: 682 (1968). 5. GRABSTALD, H. : Tumors of the urethra in men and women, Cancer 32: 1236 (1973).
343
