© 1991 S. Karger AG, Basel 0042-1138/91/0472—0105S2.75/0
Urol Int 1991;47:105-107
Solitary Urethral Recurrence of Sigmoid Colon Carcinoma Toshikazu Okaneya, Yoshihiro Inoue, Akimi Ogawa Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
Key Words. Colon carcinoma • Metastatic urethral tumor Abstract. We report a rare case of a solitary urethral recurrence of sigmoid colon cancer. The recurrence devel oped 2 years after a radical resection of sigmoid colon cancer invading the bladder. The involved portion of the urethra was resected and an end-to-end anastomosis was made. The patient has been able to urinate per urethram and has remained free of recurrence for 7 years after the urethral resection.
Introduction Metastatic urethral tumor is extremely rare. Only 1 male and 4 female cases have been reported [1-3]. In these patients, prostatic carcinoma, lung cancer, lym phoma or malignant melanoma metastasized to the ure thra as a manifestation of the generalized spread of tumor. We examined a patient who developed solitary urethral recurrence of sigmoid colon cancer and has remained free of tumor for 7 years after resection of the recurrence. Case Report Fig. 1. Urethrography shows a filling defect in bulbous urethra.
to demonstrate any other metastases. The involved portion of the urethra was resected with a perineal approach and an end-to-end anastomosis was made. The postoperative course was uneventful. Seven years after the urethral resection, the patient has remained able to urinate smoothly per urethram and showed no evidence of recurrence. Histological examination of the resected specimen re vealed a well-differentiated adenocarcinoma which was histologi cally similar to the previous colon carcinoma. Immunostaining with anti-CEA antibodies demonstrated a similar positive pattern in both the colonic and urethral tumors (fig. 2,3).
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A 47-year-old man presented with occasional diarrhea and pain less gross hematuria. Cystoscopy showed a solid, necrotic tumor at the bladder dome. Biopsy of the tumor revealed adenocarcinoma. Barium enema demonstrated a colon tumor of Borrmann type 2. The patient underwent a radical resection of the sigmoid tumor with excision of the involved bladder wall. Pathological diagnosis was ‘moderately differentiated adenocarcinoma’ with metastasis to a paracolic lymph node. The tumor was classified as stage C of Dukes’ classification. Follow-up examinations showed no evidence of recurrence until 2 years later, when the patient began to complain of initial gross hematuria. Urethrography and urethroscopy showed a papillary tumor in the bulbous urethra (fig. 1). Ultrasound and CT scan failed
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Fig. 2. a Papillary adenocarci noma of colon. HE. X 100. b Sur face coat lining tumor tissue is pos itive for CEA. Anti-CEA antibody stain. X 100.
Discussion Colon carcinoma seldom metastasizes to the genito urinary tract. Our patient developed a solitary urethral recurrence of sigmoid colon carcinoma. We could not find any record of such a case in the English literature. Why a solitary recurrence occurred in the urethra might be explained by the previous bladder involvement of sig moid colon carcinoma. Pelvic node dissection at the
radical excision brought about an altered lymphatic flow, and tumor cells left in the lymphatics of the bladder might have been conveyed to the bulbous urethra. The 5-year survival rate of the patients with Dukes’ stage C colon carcinoma who underwent curative opera tions has been reported to be nearly 30% [4, 5], Although an advanced colon carcinoma may be treated success fully by an ‘en bloc’ extirpation of the primary tumor with the regional lymph nodes, development of recur
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Fig. 3. a Papillary adenocarci noma of urethra. HE. X 120. b Sur face coat lining tumor tissue is pos itive for CEA. Anti-CEA antibody stain. X 120.
Urethral Recurrence of Colon Carcinoma
References 1 Rao MS, Bapna BC, Bhat VN, Vaidyanathan S: Multiple ure thral metastases from prostatic carcinoma causing urinary reten tion. Urology 1977;10:566-567. 2 Roberts TW, Melicow MM: Pathology and natural history of urethral tumors in females. Urology 1977;10:583-589.
3 Clarke JFB: Urethral metastasis from a presumed primary ma lignant melanoma presenting as postmenopausal bleeding. Proc SocM ed 1975;68:227-228. 4 Falterman KW, Hill CB, Markey JC, Fox JW, Cohn I Jr: Cancer of the colon, rectum, and anus: A review of 2,313 cases. Cancer 1974;34:951-959. 5 Fisher ER, Sass R, Palekar A, Fisher B, Wolmark N: Dukes’ classification revisited. Findings from the national surgical adju vant breast and bowel projects (protocol R-01). Cancer 1989;64: 2354-2360.
Received: March 26, 1990 Accepted after revision: October 18, 1990 T. Okaneya, MD Department of Urology Shinshu University School of Medicine 3-1-1 Asahi Matsumoto 390 (Japan)
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rence usually indicates a poor prognosis [4, 5]. The favorable outcome in our patient could be due to the fact that he underwent a curative operation for an advanced colon cancer and developed a resectable solitary recur rence. When a metastatic tumor is limited to the male ante rior urethra, partial resection of the urethra seems to be the treatment of choice. Even if the patient carries a poor prognosis, this procedure will relieve his urethral hemor rhage and enable him to urinate per urethram.
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Urol Int 1991;47:105-107
Solitary Urethral Recurrence of Sigmoid Colon Carcinoma Toshikazu Okaneya, Yoshihiro Inoue, Akimi Ogawa Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
Key Words. Colon carcinoma • Metastatic urethral tumor Abstract. We report a rare case of a solitary urethral recurrence of sigmoid colon cancer. The recurrence devel oped 2 years after a radical resection of sigmoid colon cancer invading the bladder. The involved portion of the urethra was resected and an end-to-end anastomosis was made. The patient has been able to urinate per urethram and has remained free of recurrence for 7 years after the urethral resection.
Introduction Metastatic urethral tumor is extremely rare. Only 1 male and 4 female cases have been reported [1-3]. In these patients, prostatic carcinoma, lung cancer, lym phoma or malignant melanoma metastasized to the ure thra as a manifestation of the generalized spread of tumor. We examined a patient who developed solitary urethral recurrence of sigmoid colon cancer and has remained free of tumor for 7 years after resection of the recurrence. Case Report Fig. 1. Urethrography shows a filling defect in bulbous urethra.
to demonstrate any other metastases. The involved portion of the urethra was resected with a perineal approach and an end-to-end anastomosis was made. The postoperative course was uneventful. Seven years after the urethral resection, the patient has remained able to urinate smoothly per urethram and showed no evidence of recurrence. Histological examination of the resected specimen re vealed a well-differentiated adenocarcinoma which was histologi cally similar to the previous colon carcinoma. Immunostaining with anti-CEA antibodies demonstrated a similar positive pattern in both the colonic and urethral tumors (fig. 2,3).
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:42:42 PM
A 47-year-old man presented with occasional diarrhea and pain less gross hematuria. Cystoscopy showed a solid, necrotic tumor at the bladder dome. Biopsy of the tumor revealed adenocarcinoma. Barium enema demonstrated a colon tumor of Borrmann type 2. The patient underwent a radical resection of the sigmoid tumor with excision of the involved bladder wall. Pathological diagnosis was ‘moderately differentiated adenocarcinoma’ with metastasis to a paracolic lymph node. The tumor was classified as stage C of Dukes’ classification. Follow-up examinations showed no evidence of recurrence until 2 years later, when the patient began to complain of initial gross hematuria. Urethrography and urethroscopy showed a papillary tumor in the bulbous urethra (fig. 1). Ultrasound and CT scan failed
106
Okaneya/Inoue/Ogawa
Fig. 2. a Papillary adenocarci noma of colon. HE. X 100. b Sur face coat lining tumor tissue is pos itive for CEA. Anti-CEA antibody stain. X 100.
Discussion Colon carcinoma seldom metastasizes to the genito urinary tract. Our patient developed a solitary urethral recurrence of sigmoid colon carcinoma. We could not find any record of such a case in the English literature. Why a solitary recurrence occurred in the urethra might be explained by the previous bladder involvement of sig moid colon carcinoma. Pelvic node dissection at the
radical excision brought about an altered lymphatic flow, and tumor cells left in the lymphatics of the bladder might have been conveyed to the bulbous urethra. The 5-year survival rate of the patients with Dukes’ stage C colon carcinoma who underwent curative opera tions has been reported to be nearly 30% [4, 5], Although an advanced colon carcinoma may be treated success fully by an ‘en bloc’ extirpation of the primary tumor with the regional lymph nodes, development of recur
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:42:42 PM
Fig. 3. a Papillary adenocarci noma of urethra. HE. X 120. b Sur face coat lining tumor tissue is pos itive for CEA. Anti-CEA antibody stain. X 120.
Urethral Recurrence of Colon Carcinoma
References 1 Rao MS, Bapna BC, Bhat VN, Vaidyanathan S: Multiple ure thral metastases from prostatic carcinoma causing urinary reten tion. Urology 1977;10:566-567. 2 Roberts TW, Melicow MM: Pathology and natural history of urethral tumors in females. Urology 1977;10:583-589.
3 Clarke JFB: Urethral metastasis from a presumed primary ma lignant melanoma presenting as postmenopausal bleeding. Proc SocM ed 1975;68:227-228. 4 Falterman KW, Hill CB, Markey JC, Fox JW, Cohn I Jr: Cancer of the colon, rectum, and anus: A review of 2,313 cases. Cancer 1974;34:951-959. 5 Fisher ER, Sass R, Palekar A, Fisher B, Wolmark N: Dukes’ classification revisited. Findings from the national surgical adju vant breast and bowel projects (protocol R-01). Cancer 1989;64: 2354-2360.
Received: March 26, 1990 Accepted after revision: October 18, 1990 T. Okaneya, MD Department of Urology Shinshu University School of Medicine 3-1-1 Asahi Matsumoto 390 (Japan)
Downloaded by: Stockholm University Library 130.237.165.40 - 1/19/2019 10:42:42 PM
rence usually indicates a poor prognosis [4, 5]. The favorable outcome in our patient could be due to the fact that he underwent a curative operation for an advanced colon cancer and developed a resectable solitary recur rence. When a metastatic tumor is limited to the male ante rior urethra, partial resection of the urethra seems to be the treatment of choice. Even if the patient carries a poor prognosis, this procedure will relieve his urethral hemor rhage and enable him to urinate per urethram.
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