Adenocarcinoma of the paraurethral glands: a case report
Francesco Massari1*, Chiara Ciccarese1*, Alessandra Modena1, Francesca Maines1, Diego Segala2, Claudio Luchini2, Lisa Marcolini2, Francesca Cavicchioli3, Stefano Cavalleri3, Emilio Bria1, Matteo Brunelli2, Guido Martignoni2, Walter Artibani3 and Giampaolo Tortora1
1Medical Oncology, 2Department of Pathology and Diagnostic and 3Urology Clinic, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), University of Verona, Verona, Italy
*Equally contributors
Offprint requests to: Francesco Massari, MD, Medical Oncology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), University of Verona, P.le L.A Scuro 10, 37134, Verona, Italy. e-mail: fmassari79@gmail.com
Summary. Adenocarcinoma of the paraurethral glands represents a very rare neoplasm of the urinary tract. Due to the rarity of this disease, there is no standard therapeutic approach. We report a case of adeno-carcinoma of the paraurethral glands in a 56-year-old woman, presenting with abnormal serous vaginal discharges. The radiologic examination revealed a 5-cm mass around the urethra, which underwent surgical resection. After surgical resection, the histology revealed a moderately differentiated adenocarcinoma, probably arising from the paraurethral glands. One month later, a pelvic recurrent mass was radiologically diagnosed; consequently, an anterior pelvic exenteration with lymph node dissection was performed. Histological examination revealed a moderately differentiated adenocarcinoma, with glandular and micropapillary architecture, with multiple lymph node metastases. The absence of modifications such as urethritis cystic glandularis on the urethral mucosa, as well as the lack of a lesion in situ, associated with the immunohisto-chemical expression of PAX8 and negativity for GATA3 and S100p, suggested that the adenocarcinoma originated from the paraurethral glands rather than from the urethral mucosa. Post-surgery CT scans revealed no evidence of metastatic disease. The patient received 6 courses of adjuvant chemotherapy with carboplatin and paclitaxel. One year after the pelvic exenteration, because of inguinal lymph node progression, an inguinal lymphadenectomy was performed. Four months later, a TC-PET revealed a multidistrectual lymph node and a lung micronodule disease progression. Invasive micropapillary carcinomas have been characterized as a rare distinctive variant of carcinomas in several anatomic sites and are distinguished by a marked tendency to lymphovascular invasion, justifying the association with high-stage disease and poor prognosis. In the present case, both the poor prognosis connected with micropapillary structure and the lymph node involvement, encouraged adjuvant cisplatinum-based chemotherapy. Histol Histopathol 29, 1295-1303 (2014)
Key words: Adenocarcinoma, Micropapillary, Paraurethral glands, Review
DOI: 10.14670/HH-29.1295