Clear cell adenocarcinoma of the female urethra: A case report

초록

Background: Clear cell adenocarcinma of the urethra is rare and several case reports or small collective series are present. This tumor usually occurs in females that age range is 22 to 83. The cytologic finding is distinctive but it needs to be differentiated from usual urothelial carcinoma, high grade. Here we present a case of primary clear cell adenocarcinoma of the female urethra with its cytologic findings. A 54-year-old woman presented in painless gross hematuria for 3 months at the outpatient clinic. She took a hysterectomy 24years ago because of uterine cancer. She had frequency, residual urine sensation, nocturia and left leg edema. On vaginal sonography, there was a sausage like elongated mass in the urethra, measuring 3.8x4.3cm. The bladder lumen was clear. The computed tomographic urography revealed 4cm sized low attenuated mass with cystic portion adjacent vaginal stump. Many 0.5-3cm sized metastatic lymphadenopathy were present in paraaortic space and pelvic cavities. On trans urethral resection, a lobulated tumor mass was present in the urethra, measuring about 3cm in diameter. The urinary bladder was clear. The voided urine cytology revealed small, rounded papillary clusters. Some clusters contained necrotic and inflammatory cells. The cells were enlarged and had abundant clear or granular cytoplasm with cytoplasmic vacuolation. The nucleus showed granular or vesicular chromatin with prominent nucleoli. The histology section showed tubulocystic pattern with papillary and cystic portions . The cells had clear or granular cytoplasm. They were cuboidal or columnar and hobnail cells were often present. The nucleus were vesicular with prominent nucleoli. Nuclear pleomorphism ranged from moderate to severe. Several eosinophilic round secretions were scattered in the tumor. These histologic findings were similar to the clear cell carcinoma of female genital tract. The histogenesis of urethral clear cell carcinoma is controversial. In the past, this tumor