Urethral caruncle

Clinicopathologic features of 41 cases

Miriam R. Conces, Sean R. Williamson, Rodolfo Montironi, Antonio Lopez-Beltran, Marina Scarpelli, Liang Cheng

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Urethral caruncle is a benign polypoid mass of the urethral meatus in primarily postmenopausal women. Although a conclusive association with malignancy, 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 identified in some cases resembling caruncle clinically. We examined clinical and histopathologic characteristics in 41 patients. Medical records were assessed for presentation, clinical diagnosis, associated urothelial carcinoma, radiation treatment, tobacco use, immunologic/urologic disorder, and treatment strategy/outcome. Average patient age was 68 years (range, 28-87 years). Presenting symptoms were pain (37%), hematuria (27%), and dysuria (20%), in contrast to asymptomatic (32%). Clinical diagnosis favored malignancy in 10% of cases. Concurrent or subsequent urothelial carcinoma was present for 5 patients (12%), although none developed 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/glandularis, without intestinal metaplasia. Two lesions included an organizing thrombus, 1 with intravascular papillary endothelial hyperplasia. Twenty patients were treated with topical medications without resolution. Three lesions recurred (7%) after excision. A subset of patients had history of smoking or previous pelvic irradiation. Urethral caruncle is an uncommon lesion that may clinically mimic benign and malignant conditions. Awareness of the spectrum of clinical and histologic differential diagnoses is important in dealing with this unusual disease.

Original languageEnglish
Pages (from-to)1400-1404
Number of pages5
JournalHuman Pathology
Volume43
Issue number9
DOIs
StatePublished - Sep 2012

Fingerprint

Carcinoma
Neoplasms
Differential Diagnosis
Dysuria
Urothelium
Urethritis
Metaplasia
Tobacco Use
Hematuria
Hyperplasia
Medical Records
Blood Vessels
Thrombosis
Smoking
Radiation
Pain
Therapeutics

Keywords

  • Caruncle
  • Urethra
  • Urethral polyp
  • Urinary bladder
  • Urinary tract

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Conces, M. R., Williamson, S. R., Montironi, R., Lopez-Beltran, A., Scarpelli, M., & Cheng, L. (2012). Urethral caruncle: Clinicopathologic features of 41 cases. Human Pathology, 43(9), 1400-1404. https://doi.org/10.1016/j.humpath.2011.10.015

Urethral caruncle : Clinicopathologic features of 41 cases. / Conces, Miriam R.; Williamson, Sean R.; Montironi, Rodolfo; Lopez-Beltran, Antonio; Scarpelli, Marina; Cheng, Liang.

In: Human Pathology, Vol. 43, No. 9, 09.2012, p. 1400-1404.

Research output: Contribution to journalArticle

Conces, MR, Williamson, SR, Montironi, R, Lopez-Beltran, A, Scarpelli, M & Cheng, L 2012, 'Urethral caruncle: Clinicopathologic features of 41 cases', Human Pathology, vol. 43, no. 9, pp. 1400-1404. https://doi.org/10.1016/j.humpath.2011.10.015
Conces MR, Williamson SR, Montironi R, Lopez-Beltran A, Scarpelli M, Cheng L. Urethral caruncle: Clinicopathologic features of 41 cases. Human Pathology. 2012 Sep;43(9):1400-1404. https://doi.org/10.1016/j.humpath.2011.10.015
Conces, Miriam R. ; Williamson, Sean R. ; Montironi, Rodolfo ; Lopez-Beltran, Antonio ; Scarpelli, Marina ; Cheng, Liang. / Urethral caruncle : Clinicopathologic features of 41 cases. In: Human Pathology. 2012 ; Vol. 43, No. 9. pp. 1400-1404.
@article{c7f2c41066b84b2289c2769cfcb2050a,
title = "Urethral caruncle: Clinicopathologic features of 41 cases",
abstract = "Urethral caruncle is a benign polypoid mass of the urethral meatus in primarily postmenopausal women. Although a conclusive association with malignancy, 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 identified in some cases resembling caruncle clinically. We examined clinical and histopathologic characteristics in 41 patients. Medical records were assessed for presentation, clinical diagnosis, associated urothelial carcinoma, radiation treatment, tobacco use, immunologic/urologic disorder, and treatment strategy/outcome. Average patient age was 68 years (range, 28-87 years). Presenting symptoms were pain (37{\%}), hematuria (27{\%}), and dysuria (20{\%}), in contrast to asymptomatic (32{\%}). Clinical diagnosis favored malignancy in 10{\%} of cases. Concurrent or subsequent urothelial carcinoma was present for 5 patients (12{\%}), although none developed 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/glandularis, without intestinal metaplasia. Two lesions included an organizing thrombus, 1 with intravascular papillary endothelial hyperplasia. Twenty patients were treated with topical medications without resolution. Three lesions recurred (7{\%}) after excision. A subset of patients had history of smoking or previous pelvic irradiation. Urethral caruncle is an uncommon lesion that may clinically mimic benign and malignant conditions. Awareness of the spectrum of clinical and histologic differential diagnoses is important in dealing with this unusual disease.",
keywords = "Caruncle, Urethra, Urethral polyp, Urinary bladder, Urinary tract",
author = "Conces, {Miriam R.} and Williamson, {Sean R.} and Rodolfo Montironi and Antonio Lopez-Beltran and Marina Scarpelli and Liang Cheng",
year = "2012",
month = "9",
doi = "10.1016/j.humpath.2011.10.015",
language = "English",
volume = "43",
pages = "1400--1404",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",
number = "9",

}

TY - JOUR

T1 - Urethral caruncle

T2 - Clinicopathologic features of 41 cases

AU - Conces, Miriam R.

AU - Williamson, Sean R.

AU - Montironi, Rodolfo

AU - Lopez-Beltran, Antonio

AU - Scarpelli, Marina

AU - Cheng, Liang

PY - 2012/9

Y1 - 2012/9

N2 - Urethral caruncle is a benign polypoid mass of the urethral meatus in primarily postmenopausal women. Although a conclusive association with malignancy, 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 identified in some cases resembling caruncle clinically. We examined clinical and histopathologic characteristics in 41 patients. Medical records were assessed for presentation, clinical diagnosis, associated urothelial carcinoma, radiation treatment, tobacco use, immunologic/urologic disorder, and treatment strategy/outcome. Average patient age was 68 years (range, 28-87 years). Presenting symptoms were pain (37%), hematuria (27%), and dysuria (20%), in contrast to asymptomatic (32%). Clinical diagnosis favored malignancy in 10% of cases. Concurrent or subsequent urothelial carcinoma was present for 5 patients (12%), although none developed 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/glandularis, without intestinal metaplasia. Two lesions included an organizing thrombus, 1 with intravascular papillary endothelial hyperplasia. Twenty patients were treated with topical medications without resolution. Three lesions recurred (7%) after excision. A subset of patients had history of smoking or previous pelvic irradiation. Urethral caruncle is an uncommon lesion that may clinically mimic benign and malignant conditions. Awareness of the spectrum of clinical and histologic differential diagnoses is important in dealing with this unusual disease.

AB - Urethral caruncle is a benign polypoid mass of the urethral meatus in primarily postmenopausal women. Although a conclusive association with malignancy, 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 identified in some cases resembling caruncle clinically. We examined clinical and histopathologic characteristics in 41 patients. Medical records were assessed for presentation, clinical diagnosis, associated urothelial carcinoma, radiation treatment, tobacco use, immunologic/urologic disorder, and treatment strategy/outcome. Average patient age was 68 years (range, 28-87 years). Presenting symptoms were pain (37%), hematuria (27%), and dysuria (20%), in contrast to asymptomatic (32%). Clinical diagnosis favored malignancy in 10% of cases. Concurrent or subsequent urothelial carcinoma was present for 5 patients (12%), although none developed 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/glandularis, without intestinal metaplasia. Two lesions included an organizing thrombus, 1 with intravascular papillary endothelial hyperplasia. Twenty patients were treated with topical medications without resolution. Three lesions recurred (7%) after excision. A subset of patients had history of smoking or previous pelvic irradiation. Urethral caruncle is an uncommon lesion that may clinically mimic benign and malignant conditions. Awareness of the spectrum of clinical and histologic differential diagnoses is important in dealing with this unusual disease.

KW - Caruncle

KW - Urethra

KW - Urethral polyp

KW - Urinary bladder

KW - Urinary tract

UR - http://www.scopus.com/inward/record.url?scp=84864284228&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864284228&partnerID=8YFLogxK

U2 - 10.1016/j.humpath.2011.10.015

DO - 10.1016/j.humpath.2011.10.015

M3 - Article

VL - 43

SP - 1400

EP - 1404

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

IS - 9

ER -