CASE REPORT article
Front. Oncol.
Sec. Cancer Imaging and Image-directed Interventions
This article is part of the Research TopicCommunity Series in Biomarker Discovery and Therapeutic Innovations in Genito-Urinary Cancer Management Volume IIView all 9 articles
Case Report: Primary Clear Cell Adenocarcinoma of the Urethra - Imaging Features and Literature Review
Provisionally accepted
- Gejiu People's Hospital, Gejiu, China
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Background: Primary clear cell adenocarcinoma of the urethra (PCCAU) is an extremely rare malignant tumor. Its clinical manifestations are nonspecific, and preoperative diagnosis relies primarily on imaging studies. To date, most reports on this disease are isolated case presentations, and systematic studies correlating imaging findings with pathological results remain scarce. Case presentation: A 58-year-old female was admitted due to voiding dysfunction for 14 months, worsened with gross hematuria for 2 months. Preoperative imaging evaluation included ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Ultrasound revealed an irregular hypoechoic mass in the post-bladder urethral region with minimal internal blood flow; CT scan indicated a heterogeneously enhancing mass in the urethral area accompanied by necrotic changes; MRI demonstrated a periurethral lesion showing slightly high signal on T2-weighted imaging (T2WI) with a low-signal capsule, Diffusion-weighted imaging (DWI) showed restricted diffusion, with an apparent diffusion coefficient (ADC) value of 0.79 × 10⁻³ mm²/s, heterogeneous enhancement in the arterial phase of dynamic contrast-enhanced imaging, and a centripetal filling pattern. Postoperative histopathology confirmed the diagnosis of primary clear cell adenocarcinoma of the urethra (PCCAU). Immunohistochemical findings were as follows: AE1/AE3 (+), CK7 (focal +), PAX8 (+), P504S (+), Napsin A (scant +), p53 (~5%+), and Ki-67 (~35%+). The patient declined adjuvant therapy after surgery. Seven months postoperatively, she developed lymph node metastasis and peristomal metastasis around the right ureteral abdominal wall orifice, and was subsequently treated with toripalimab immunotherapy. She remained alive at the 1-year postoperative follow-up. Conclusions: Primary clear cell adenocarcinoma of the urethra is extremely rare. Imaging examinations, particularly multimodal MRI, combined with histopathological and immunohistochemical analyses, play a crucial role in its diagnosis. Early surgical intervention contributes to improved prognosis, and personalized treatment strategies, including immunotherapy, may offer clinical benefits in advanced cases.
Keywords: case report6, Clear cell adenocarcinoma1, Diagnosis5, Diffusion-weighted imaging4, magnetic resonance imaging3, Urethral neoplasms2
Received: 19 Sep 2025; Accepted: 04 Feb 2026.
Copyright: © 2026 Yang, Long, Zhou, Wu, Deng, Huang and Xiong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zheng Xiong
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