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Answer:
Vaginal smear - diagnosis
- Adenocarcinoma, not otherwise
specified (NOS)
Speculum examination:
- small dimple in the anterior vagina
PV: - submucosal nodule --> biopsy
- dx - Adenocarcinoma
Cystoscopy:
- blood oozing from the urethral wall
Urethrectomy and excision of the anterior vaginal wall was performed
Vaginal wall - a point of haemorrhage
Urethra
- 2cm tumor located within an arc-shaped cavity beneath the urethra
- tumor connected to the vaginal dimple via a fistula
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Histological examination
- Tumor arisen within a "diverticulum"
- Variety of patterns - tubulocystic, papillary, diffuse
- Cuboidal cells, hobnail cells with clear to eosinophilic cytoplasm, mitosis frequent
Diagnosis
Urethral clear cell adenocarcinoma
- Arising within a "diverticulum"
- communicates with the anterior vaginal wall via a fistular tract
Clear cell adenocarcinoma
- Uncommon, 15% of urethral cancer in women, 1% in man
- Predilection for women, 33 to 73 yrs
- haematuria, dysuria, discharge, pain
- 56% arising within a urethra diverticulum
- Arisen within normally located paraurethral structures that have become dilated
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