Female Urethral Adenocarcinoma Posing a Diagnostic Challenge

Generally, urethral malignancies are uncommon urological tumors that are more frequent in women than in men. The etiology of female urethral adenocarcinoma is yet unknown. Recurrent UTIs and urethral diverticula are two common risk factors linked to it. Clinical presentations can differ and are not always specific. A complete history and physical examination are part of management; urethrocystoscopy with urethral biopsy is used for diagnosis; investigations such as magnetic resonance imaging or abdominal computed tomography scans are used for staging; and treatment options include monotherapy and multimodal therapy. A 53-year-old female who presented with a 9-month history of lower urinary tract symptoms characterized by a burning sensation when passing urine, increased urinary frequency, and a feeling of incomplete bladder emptying associated with a feeling of a vaginal mass. A fixed fungating mass at the external urethral orifice was seen. Pelvic magnetic resonance imaging reported a retropubic urethral mass with bilateral inguinal lymph nodes. She underwent urethrocystoscopy with multiple urethral biopsies taken, and the specimen was sent for histopathology, which confirmed a well-differentiated urethral adenocarcinoma with mucin production. She was treated with chemoradiotherapy as per multidisciplinary team (MDT) meeting recommendations. She developed symptoms of radiation proctitis, which were treated with argon plasma coagulation. She has since been on follow-up at our oncology clinic, and a subsequent positron emission tomography CT scan reported no tumor recurrence or metastasis. She is currently doing well with no recurrence of symptoms. Although female urethral adenocarcinoma is uncommon, it requires comprehensive investigation when it is suspected, particularly in women who have nonspecific or recurrent lower urinary tract symptoms. Management should involve a MDT approach where available. Depending on the disease's stage and location, treatment options may include surgery, nonsurgical options such as radiotherapy and chemotherapy, or a combination. Patients should be monitored for any signs of recurrence of the illness. A better prognosis is said to exist for distal urethral cancers that are localized.