Urethral Caruncle: Clinicopathologic Features of 41 Cases
Sean R Williamson, Miriam R Conces, Rodolfo Montironi, Antonio Lopez-Beltran, Marina Scarpelli, Liang Cheng. Indiana University School of Medicine, Indianapolis; Polytechnic University of the Marche Region (Ancona), Ancona, Italy; Cordoba University, Cordoba, Spain
Background: Urethral caruncle is a benign polypoid mass, occurring at the urethral meatus in primarily postmenopausal women, characterized by hyperplastic epithelium overlying a variably fibrotic, vascular, and inflamed stroma. Although a conclusive association with malignancy, other urologic disorder, or systemic disease has not been established, often the lesion carries a challenging clinical differential diagnosis that includes malignancy. Conversely, unexpected malignancy is sometimes identified in tissue specimens from lesions believed to represent urethral caruncle.
Design: We examined clinical and histopathologic characteristics in 41 patients. Medical records were assessed for presentation, clinical diagnosis, associated urothelial carcinoma, prior radiation treatment, tobacco use, immunologic or urologic disorder, and treatment strategy/outcome.
Results: Average patient age was 68 (range 28–87 years). Presenting symptoms included pain (37%), hematuria (27%), and dysuria (20%). Thirteen patients were asymptomatic (32%). Clinical diagnosis favored malignancy in 10% of cases. Concurrent or subsequent urothelial carcinoma was present for five patients (12%), involving sites elsewhere in the urinary tract. No patient had synchronous or metachronous urethral carcinoma. Histologic features included mixed hyperplastic urothelial and squamous lining, overlying a variably fibrotic, edematous, inflamed, and vascular stroma. Invaginations of urothelium extending into the stroma were common (68%), showing rounded nests with cystic or glandular luminal spaces, similar to urethritis cystica or urethritis glandularis. Intestinal metaplasia was not seen. Two lesions included an organizing thrombus, one with intravascular papillary endothelial hyperplasia or Masson tumor. Twenty patients were treated with topical medications prior to tissue diagnosis without resolution. Three patients were treated for recurrence (7%).
Conclusions: Urethral caruncle is a polypoid urethral lesion that may clinically mimic a variety of benign and malignant conditions. Tissue diagnosis is important, as the clinical differential diagnosis includes malignancy in a subset of cases. We found no conclusive association with urothelial carcinoma, smoking, or previous pelvic irradiation.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 146, Wednesday Afternoon