Urethral diverticulum carcinoma management: a case report and review of the literature

BACKGROUND: Female urethral diverticulum carcinoma (UDC) is an exceptionally rare malignancy within the female urogenital system. The reported incidence of urethral diverticulum in females ranges from 0.02% to 6%, with malignant transformation occurring in an even smaller subset of cases. The extreme rarity of this condition has significantly constrained both basic research into its pathogenesis and the accumulation of clinical experience in its management. CASE PRESENTATION: A 46-year-old Han Chinese female presented with a 2-year history of increased urinary frequency, urgency, and dysuria. Pelvic MRI with contrast enhancement revealed a well-defined neoplastic lesion measuring 4.9 × 4.9 × 5.1 cm surrounding the urethra. Urethroscopic examination and radiological evaluation showed a urethral diverticulum suspicious for malignancy. Histopathological analysis of the biopsy specimen indicated papillary carcinoma. The patient underwent anterior pelvic exenteration, ileal conduit urinary diversion, and vaginal reconstruction. Postoperative pathological examination suggested high-grade urothelial carcinoma with glandular differentiation in the urethra, with evidence of invasion into the muscular layer of the bladder wall. CONCLUSIONS: UDC presents significant diagnostic challenges due to its nonspecific clinical manifestations and frequent delays in diagnosis, underscoring the importance of comprehensive physical examinations, including meticulous vaginal palpation, and advanced diagnostic procedures, such as cystoscopy with biopsy. The optimal treatment paradigm remains elusive, emphasizing the critical need for further clinical research, enhanced international collaboration, and the establishment of standardized treatment protocols to improve therapeutic outcomes for this rare and clinically challenging disease entity.