J Korean Med Sci.  2009 Feb;24(1):162-165. 10.3346/jkms.2009.24.1.162.

Endometrioid Adenocarcinoma in Urethrovaginal Septum: A Diagnostic Pitfall

• Lim MC
• Lee SM
• Lee J
• Choi HJ
• Lee S
• Huh CY
• Park SY

• KMID: 1794425
• DOI: http://doi.org/10.3346/jkms.2009.24.1.162

Abstract

Primary endometrioid adenocarcinoma developed at urethrovaginal septum has not been reported. A 61-yr-old woman presented with recurrent urinary tract infection. She had received hormone replacement treatment with estrogen and progesterone for 5 yr. A pinpoint ulceration at slightly elevated anterior vaginal wall was found and biopsy revealed endometrioid adenocarcinoma. Magnetic resonance imaging showed the 4.3 cm sized mass in urethrovaginal septum. She has undergone anterior pelvic exenteration, pelvic lymph node dissection, and urostomy with ileal conduit. Microscopic finding of the pathology revealed endometrioid adenocarcinoma. Co-existence of endometriosis was not identified. Tumor at urethrovaginal septum was difficult to be detected till growing to be bulky, because of vaginal axis, misunderstanding of the tumor as symphysis pubis, no definitive symptom, and its rarity. This is the first reported case of extraovarian endometrioid adenocarcinoma developed at the urethrovaginal septum. Understanding normal functional anatomy and meticulous physical examination are essential to detect this rare tumor in the urethrovaginal septum.

Keyword

Carcinoma, Endometrioid; Urethrovaginal Septum

MeSH Terms

Carcinoma, Endometrioid/*diagnosis/pathology/surgery
Diagnosis, Differential
Endometrial Neoplasms/*diagnosis/pathology/surgery
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Urethral Neoplasms/*diagnosis/pathology/surgery
Vaginal Neoplasms/*diagnosis/pathology/surgery

Figure

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  Fig. 1 T2-weighted sagittal MR image shows an ovoid and solid mass between urethra and vagina. Note the ill-defined margin of mass (arrows) with bladder and urethra suggesting invasion.

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  Fig. 2 Endometrioid adenocarcinoma in the urethrovaginal septum. (A) Posterior surface of gross surgical specimen of anterior pelvic exenteration. Defect in vaginal wall from previous punch biopsy was seen in the center of the elevated mass. (B) Microscopic finding of endometrioid adenocarcinoma (H&E, ×40).

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  Fig. 3 Illustration of "retropubic shadow". (A) Vaginal axis formed by levator ani make the upper third of the vagina lays almost horizontally to the 3rd & 4th sacral vertebrae. (B) Meticulous bimanual pelvic examination (full line). A procedure that incorporates scrubbing towards the posterior aspect of the pubic bone as pulling out intravaginal fingers while bending of fingertips above symphysis pubis to palpate urethrovaginal mass should be carried out after routine bimanual pelvic examination (dotted line).

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