Case Report Carcinosarcoma in the Region of the Female Urethra zyx Naoko Konno,'" Masaya Mori,' Yuji Kurooka,' Shuji Kameyama,' Yukio Homma,' Nobuo Moriyama,' Atsushi Tajima,' Takeo Murayama13 and Kazuki Kawabe' Departments of 'Urology, and 2Pathology, Faculty of Medicine, University of Tokyo, Tokyo, Japan, and 3Department of Urology, Tokyo Metropolitan Ebara Hospital, Tokyo, Japan A 61 -year-old woman with acute urinary retention was found to have a carcinosarcorna in the region zyx of the urethra. Evaluation of the computed tomogram suggested a urethral tumor, which was resected by a transperineal approach. She received local radiotherapy after surgery, and is alive at 1 -year follow- up with a tumor metastasis to the pelvis. Int J Urol 1997;4:229-231 Key words: calculi, urease, laparoscopy __ INTRODUCTION Carcinosarcoma of urologic origin is very rare except for sporadic cases occurring in the bladder. We de- scribe the case of a woman with a carcinosarcoma in the region of the urethra. CASE REPORT A zyxwvutsrqpo 6 1 -year-old woman was admitted to our hospital for the evaluation of a urethral tumor. Three weeks be- fore this admission, she was treated with a urethral catheterization to relieve an acute miction pain and spontaneous urinary retention. She had no history of macrohematuria or urinary disturbance. She had an oophorectomy for ovarian cyst (side unclear) at 29 years of age. A smooth and undulated tumor (4 x 5 x zyxwvu 5 cm) was found during an intravaginal examination. The computed tomography (CT) and magnetic reso- nance imaging (MRI) scans showed a cystic lesion filled with a papillary mass, surrounding the urethra (Fig. 1). No abnormalities were detected in the uterus or residual adnexa. Endoscopic examination showed no tumor lesions on the urethral mucosa. Findings from intravenous pyelography were normal upper uri- nary tracts. Serum tumor markers (carcinoembryonic antigen, /%human chorionic gonadotropin, zyxwvu a- fetoprotein, carbohydrate antigen 19-9, and prostate- specific antigen) were not elevated in the whole course. The cytologic analysis of the tumor aspirate was positive for malignancy (grading system class 5; adenocarcinoma), while the urine sample was nega- tive for malignant cells. The tumor was excised by a transperineal ap- Received May 9, 1996; accepted for publication in revised form Sep. 9, 1996. *Correspondence and requests for reprints to: Depart- ment of Urology,' University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 11 3, Japan. proach, and urinary diversion by cystostomy was per- formed. The tumor was smoothly detached from the vaginal wall, but adhesive to the urethra. The pathologic diagnosis was carcinosarcoma with heterologous differentiation in the region of the ure- thra, including a carcinoma, adenocarcinoma, and partly, squamous cell carcinoma and chondrosarcoma (Fig. 2). The urethral mucosa had no evidence of transitional cell carcinoma. The patient was discharged after local radiation therapy of 50 Gy. At the 12-month follow-up, she was treated in the outpatient ward for a tumor metastasis to the pelvic bone. DISCU SSl ON Microscopic examination of the excised tumor tissue showed a carcinosarcoma composed of mainly adenocarcinoma, resembling mesodermal mixed tumor with several foci of chondrosarcoma. The pri- mary site was not clearly identified, because of the advanced stage of the tumor at the time of the exami- nation. The uterus and its adnexa showed no tumor- ous lesion, either by preoperative imaging diagnostic technology or during the intraoperative examination. The primary site is most likely the proximal urethra or paraurethral gland. Urethral carcinoma is very rare. Seventy percent of the cases occur in women. Sarcoma of the urethra is extremely rare. McCrea collected 523 cases of pri- mary carcinoma of the female urethra, but only 23 cases of the sarcoma of female urethra (approximately 20 : 1). Although cases of carcinosarcoma of the blad- der have been reported sporadically, urethral carcinosarcoma has not previously been seen in our review of the litekature. The tumors have a polypoid appearance in general, and also in our case study. Twenty-five percent to 50% of the cases have mesenchymal elements such as skeletal muscle and 0919-81 72/97/0402-0229/US$03.00 zyxwvutsr 0 JUA/CLJ 1997 229