Year : 2006 | Volume
: 16 | Issue : 4 | Page : 905--906
Imaging features of carcinoma of male urethra
S Sharma, N Agarwal, A Negi, S Makhaik
1007, Basant vihar, Kasumpti, Shimla-171009, Himachal Pradesh, India
1007, Basant vihar, Kasumpti, Shimla-171009, Himachal Pradesh
|How to cite this article:|
Sharma S, Agarwal N, Negi A, Makhaik S. Imaging features of carcinoma of male urethra.Indian J Radiol Imaging 2006;16:905-906
|How to cite this URL:|
Sharma S, Agarwal N, Negi A, Makhaik S. Imaging features of carcinoma of male urethra. Indian J Radiol Imaging [serial online] 2006 [cited 2021 Jan 18 ];16:905-906
Available from: https://www.ijri.org/text.asp?2006/16/4/905/32380
Tumors of the male urethra are rare, comprising less than 1% of all urologic cancers. 60% occur in patients older than 65 years of age . Risk factors of urethral carcinoma are chronic irritation, inflammation, trauma, strictures, chronic urinary stasis etc . We are presenting here a case of urethral squamous cell carcinoma in a 47 year old man.
A forty seven years old man presented with complaints of swelling in left inguinal region for two months. On clinical examination inguinal lymph nodes were enlarged on both sides, left more than right. FNAC of inguinal lymph nodes revealed metastatic squamous cell carcinoma. Urethral tumor was suspected and retrograde urethrography was performed.
RGU: Revealed two irregular filling defects in the dilated bulbar part of anterior urethra(Fig 1). The margins of the involved urethra were irregular with evidence of extension of the mass into periurethral soft tissues. The penile urethra was normal.
USG : There were two irregular hypoechoic masses in the bulbar urethral region(Fig 2). They measured 19x15 mm and 16x19mm. The central part of these masses was more hypoechoic as compared to its periphery suggestive of neorosis. Entarged hypoechoic lymph nodes were seen in bilateral inguinal regions. No other enlarged abdominal or pelvic lymph nodes were detected. Liver, pancreas, spleen and both kidneys were normal.
On Colour Doppler Sonography. The urethral masses revealed marked peripheral vascularity with no signal in the centre suggestive of necrosis.
CT: Pelvis showed irregular hypodense masses in the region of anteior urethra which showed inhomogeneous enhancement after IV contrast with areas of central necrosis(Fig 3). Multiple bilateral entarged inguinal lymph nodes were seen which also showed peripheral enhancement.
On the basis of RGU, USG, Colour Doppler, CT and FNAC the diagnosis of urethral carcinoma stage D1 was made.
In male patients, approximately 60% of tumors occur in the bulbo-membranous region, 34% are in the penile or distal bulbous urethra, and 6% arise in the prostatic urethra . Most reports indicate that squamous cell tumors are the most common type occurring in 50% to 78% . Often there is assoiation with stricture of the urethra. Infrequently transitiional cell carcinoma or undifferentiated tumor may predominate at the bladder neck or within the prostatic urethra.
On the basis of prognosis and treatment male urethral carcinoma is classified into two groups . Group I consists of carcinoma involving the external meaturs, the urethra, the penoscrotat junction and the distal bulbous urethra. Group 2 occurs in the proximal bulbous urethra, membranous and prostatic urethra. Patients with CPI present with early sign and symptoms and are diagnosed in short period of time (average 11 months). At time of diagnosis, 45% are in stage C or D where as in GP II discovery of carcinoma occurs in approx, 18 months. In more than 89% of patients with proximal urethral tumor staging reaches stage C or D when tumor is found. For urethral cancer, the incidence of nodal metastasis is 14% to 30%.
Accurate staging of urethral carcinoma is vital to careful treatment planning and estimation of prognosis. No universally accepted staging system exists for cancer of male urethra.
Staging of urethral carcinoma
O Confined to mucosa only (in situ).
A Invasion into but not beyond the lamina propria.
B Direct extension into but not beyond the substance of the corpora spongiosum, or into but not beyond the prostate.
C. Direct extension into the tissues beyond the corpus spongiosum (corpora cavernosa, muscle, fat, fscia, skin, direct skeletal involvement) or beyond the prostate.
D1 Regional metastasis, including inguinal or pelvic lymph nodes.
D2 Distant metastasis (with any primary).
Imaging of Urethral Carcinoma
Retrograde Urethrography and Voiding Cystourethrography are corner stones of detection, definition and evaluation of complications for the variety of urethral tumor and tumor like lesions. RGU is ideal for evaluating anterior urethral masses in male patients, whereas VCU is good for posterior urethral tumor in male patients. However its limitation is that it assesses only intraluminal features of urethral tumors and may impose technical limitations if patient has high degree of urethral obstructions. It is also unable to display the depth of turnor invasion into the urethral wall of cropus spongiosum, invasion of adjacent structues and metastasis. Its advantage is demonstration of location and length of intraturnianl involvement of posterior urethra. RGU in our case.
USG : Transperinial USG has limited utility in the diagnosis and staging of urethral tumors. Penile USG with high frequently transducer has demonstrated an ability to diagnose the extent of urethral involvement from benign strictures . Colour doppler may demonstrate increased vascularify there by aiding in the differentiation of benign from the malignant causes.
CT SCAN : Conventional CT has been of limited usefulness for evaluating the local extent of urethral tumor because of limitation to the axial plane and limited contrast resolution for soft tissues which may be partially overcome by helical scanning. It may reveal soft tissue masses, involvement of other adjacent organs, lymph nodes and is used for staging.
RGU is the modality of the choice in male urethral tumors, CT, USG and Doppler studies are complimentary to RGU.
|1||Lynch CF, Cohen MB: Urinary system. Cancer 75:1995:316-29.|
|2||Poore RE, Howards SS, Duckett JW (eds): Adult and pediatric urology, 3rd edition St Louis, Mosby-Year book, 1996;1837.|
|3||Ray B, Gwnan PD: Primary carcinoma of urethra, In Jawadpour N (ed): Principles and management of urologic cancer. Baltemore, Williams and Williams; 1979:445.|
|4||Hopkins SC, Grabstald H: Tumors of the male and female urethra. In Walsh P, Gittes RF, Perlmutter et al (eds); Campbells Urology, 5th edition Philadelphia, WB Saunders, 1986:1449.|
|5||Carroll PR: Surgical management of urethral carcinoma. Jn Crawford ED: Current genitor-urinary cancer surgery, Philidelphia, Lea and Febiger, 1990;380.|
|6||Das D: Ultrasonographic evaluation of urethral stricutre disease. Urology, 1992;40:237.|