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Adenocarcinoma of urethral diverticulum

Dr Praveen Jha et al.

Urerthral diverticulum adenocarcinoma is a rare condition, when carcinoma arises in urethral diverticulum.

Epidemiology

It is seen in approx. 0.6-6% women.

Clinical features

Urinary frequency, urgency, burning micturition and dysuria are usual presenting symptoms¹ . However, tender cystic swelling protruding from vagina, dribbling and dyspareunia are more specific symptoms.

Pathology

Urethral diverticulum carcinoma comprises of transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma. Adenocarcinoma is the most common malignancy (60%)².

Radiological features

VCUG

Contrast filled outpouching from urethra with partial fill-in/contrast retention during voiding. Adenocarcinoma is seen as filling defect within the diverticulum² .

Double balloon urethrography

Double balloon urethrography can be used to forcefully inject contrast into diverticular orifice. Filling-defects can be relatively better identified.

USG

On transabdominal ultrasound, distended urethral diverticulum is seen posterior to urinary bladder (in females, it is a similar location to prostate), with a polypoidal or diffuse mass lesion within.

Transvaginal or endourethral ultrasound may detect it in much better way.

CT

Well defined thick-walled cystic lesion, at the level of pubic symphysis, with enhancing mass lesion within. CT also stages the urethral diverticulum adenocarcinoma, in terms of local or regional invasion. It can also easily differentiates diverticular calculi, which may mimic carcinoma on VCUG.

CT voiding urethrography

2D-3D reconstruction and virtual endoscopy can better depict the diverticulum and carcinoma arising in it.

MRI

T1: Diverticulum is seen as hypointense signal area within enlarged urethra, or sometimes homogenous hypointense signal enlarged urethra. A carcinoma as heterogenous enhancing mass with thickened wall of diverticulum.

T2: Diverticulum is seen as hyperintense signal area within enlarged urethra.

Fiberoptic urethroscopy

Diverticulum can be well visualized on urethroscopy, if the orifice is well identified.

Differential diagnosis

vaginal adenocarcinoma
vaginal metastases
calculi in diverticulum (may appear as filling-defect in VCUG)

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