Citation 泌尿器科紀要 (1981), 27(11):

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泌尿器科紀要 (1981), 27(11): 1393-1397 Issue Date 1981-11 URL http://hdl.hle.

1 Title METASTATIC URETHRAL TUMOR FROM CARC OF THE BREAST: A CASE REPORT Author(s) Tanaka, Yoichi; Okabe, Tatsushiro; Kiyiyama, Tadao; Yoshida, Osamu Citation 泌尿器科紀要 (1981), 27(11): Issue Date URL Right Type Departmental Bulletin Paper Textversion publisher Kyoto University

2 1393 CActa Ural. Jap. Vol. 27 No. 11, November 1981_ METASTATIC URETHRAL CARCINOMA OF THE BREAST TUMOR FROM : A CASE REPORT Yoichi TANAKA, Tatsushiro OKABE, Kenichiro OKADA Tadao KIRIYAMA Osamu YOSHIDA From Department Urology, Faculty Medicine, Kyoto University (Director: Pr. 0. Yoshida, M.D.) A 57-year-old woman with a external meatus a previous primary carcinoma breast was presented. Diagnosis urethra was made at excision biopsy its simultaneous development in a series generalized metastases. The perusal Japanese literatures shows that re has been only one case reported up to date. Key words: Metastatic, Breast carcinoma INTROD UCTION It is well known that carcinomas arising neighboring organs urethra can come in contact with or grow into urethra. It occurs not infrequently in carcinoma bladder, prostate, rectum uterus. However, extremely rare is urethra when primary lesion is in a remote site. A case carcinoma breast is herein reported. CASE REPORT A 57-year-old woman was admitted to department Urology Kyoto University Hospital on May 29, 1980 for evaluation a external meatus. She underwent a radical mastectomy in anor hospital for left breast cancer in January A pathological report surgical specimen was infiltrating duct carcinoma breast. Postoperatively, patient received 6000 rads supervoltage radiation to sternal left axillary region. Although she had not been under close follow-up, but was free any particular symptom for about one year, except for coughing. Three months prior to present admission patient began to notice general malaise genital bleeding in straining for defecation. Thereafter she noticed several episodes genital bleeding so that she went to see a gynecologist was informed presence a external meatus. The physical examination disclosed a somewhat ill woman. Extending left anterior chest to left axillary region, re was an operation scar. Respiratory sound decreased over right lower lung field. The liver was enlarged 5 cm below right costal margin with firm consistency. There was no palpable lymphadenopathy. The hard in a little finger head size with central necrosis was present on posterior lip external meatus ( 1). The patient underwent extensive laboratory x-ray evaluations. Routine laboratory studies multichannel chemistries were within normal limits except for increased ESR high level LDH. Arterial gas analysis revealed decreased Po,. Chest x-ray revealed multiple coin lesions in both lung fields, especially huge one in right lower lung field ( 2). Urography was in normal findings. The excision biopsy was done under suspicion lesion breast cancer. The was localized in submucosal space with intact overlying uroepilium, was consistent with infiltrating duct

Acta Tirol. 1394 Jap. Vol. 27. No. 11. 1981.- v / 6. ` ` rt. f 4-. l r1~, 1. Tumor with central necrosis at external tt meatus. I ha * M! ~ m r~~a r. _. s,i(.t ~! - 2.

3 Acta Tirol Jap. Vol. 27. No v / 6. ` ` rt. f 4-. l r1~, 1. Tumor with central necrosis at external tt meatus. I ha * M! ~ m r~~a r. _. s,i(.t ~! - 2. G tiest lesions x-ray on admission, in both lung showing fields. several coin 3. Biopsy external showing urolium invasion rtg. +. Lever sctnttgrant intact at meatus, covering submucosal

Tanaka et al.: Metastatic carcinoma1395 to lymphoma or leukemia. 4) Those that reach urethra by lymphogenors or hematogenous metastasis a primary focus in a distant organ.

4 Tanaka et al.: Metastatic carcinoma1395 to lymphoma or leukemia. 4) Those that reach urethra by lymphogenors or hematogenous metastasis a primary focus in a distant organ. Several cases group 3 have been reported as ". However, every organ has at least some amount lymphatic tissue, s group 3 should not L 5. U# Tl! Brain CT, Llit6T T., demonstrating with marked ring eaema refore but infiltration or enhanced be carcinoma mammary gl in pathohistological (3) figures. Liver scintiscan revealed also multiple lesions with hepatomegaly ( 4). About one week after admission, speech disturbance incomplete hemiplegia appeared gradually got worse. Brain CT disclosed a Accordingly, concluded by rence. The so Although Department three alized an months it to patient did not staged reafter, she Tumors be right true multicentric group for a contiguous 4 should a true. Extremely. rare In malignant a s, uterine is series two malignant al. found cases, only et al. case one Mrcog malignant melain review s, Roberts et Perusal Japanese literature shows that re has been only one reported case cancer patient, died gener- carcinomatosis. DISCUSSION Urethral s may be classified as primary or secondary disease. Secondary s may be furr subdivided into 4 groups as follows; 1) Those that reach urethra by direct extension a primary focus in an adjacent organ, such as bladder, prostate, rectum or vagina. 2) Those that develop simultaneously in urethra bladder or renal pelvis ureter as a result stimulation by an unknown carcinogen multicentric premalignant foci present in urolial tract. 3) Those that involve urethra secondary lung one found metastasizing only autopsies involvement Rao prostatic cancer noma respectively4,5) Klinger cancer3>. reported recur- to treatment as distant. transferred for to a cancer patient allow was Surgery advanced breast was condition that treatment generalized general poor furr care as a metastasis followed was edema. taken considered as a asynchronous development2 surroundings. with marked surroundings ( 5). be metastasis cancer6. gastric cancer up to date). To our knowledge, our case is second reported case. In 2843 autopsies carcinoma breast Annual pathological autopsy cases in Japan, we found one involvement. Breast cancer is one malignant s prone to blood born metastasis. About 60% recurrence is considered to be caused by hematogenous metastasis. Histologically, infiltrating duct carcinoma scirrhous carcinoma appear to be type most likely to have blood born spread, which comprise about 50% hematogenous metastasis8-10). The sites metastasis 2843 autopsies breast cancer Annual pathological autopsy cases in Japan ( ) are summarized in Table I. Of se, 445 at autopsy have metastases to genitourinary organs, an over-all incidence 15.6 per cent. The commonest genitourinary organs involved are first, kidney, second, bladder. The

5 1396 Table 1. The sites patholgical Acta Urol. Jap. Vol. 27, No. 11, metastasis 2843 autopsies cancer autopsy cases in Japan ( ) 1981 breast Annual Orgons Cases 500 I C 2000 Lymph node Lung Bone Liver Pleura Adrenal gl Skin Kidney Brain Ovary Thyroid Spleen Pericardium Peritoneum Pancreas St tissues Heart Diaphragma Uterus Duro mater Stomach Intestine Pituitary Gall bladder Opposite breast Meninx Mediastinum Urinary bladder Ureter Urethra Table 2. Metastasis to genito-urinary organs in 2843 autopsies carcinoma Annual pathological autopsy cases in Japan ( ) cases site breast. kidney 1 bladder ureter urethra testis penis Total 445 No. kidney bladder ureter urethra testis penis % 13.7% 1.2% 0.7% 0.003% 0 0 urethra is involved in only one instance among m, an incidence per cent (Table 2)8,10) Because rarity in comparison with incidence primary disease, it may be necessary to distinguish it double cancer; breast cancer primary adenocarcinoma in this case. On making diagnosis, Price et al.11) Hermann12> present several referential factors as follows : ClinicaIly, patients age simultaneous development in a series generalized metastasis.

A rare case of adenocarcinoma of bl augmentation enterocystoplasty. Citation 泌尿器科紀要 (1985), 31(2):

Title A rare case of adenocarcinoma of bl augmentation enterocystoplasty Author(s) KAMIDONO, Sadao; ARAKAWA, Soichi; U ISHIGAMI, Jodi; MAEDA, Sakan Citation 泌尿器科紀要 (1985), 31(2): 315-318 Issue Date 1985-02