Pathology and natural history of urethral tumors in males Review of 142 cases

A series of 142 tumors of the male urethra is presented. The natural history of these neoplasms is dependent not only on the cell type, but also on the site of origin. A concept concerning the latter is presented and illustrated. The urethra is divided into three zones: A, B, and C. Zone A includes the meatus, fossa navicularis, and distal pendulous urethra. Here the neoplasms were discovered relatively early, treatment in most instances was efficacious, and results were good. Zone B includes the proximal (fixed) urethra and bulbomembranous junction. Here there was often considerable delay in establishing a correct diagnosis because many of the patients were suspected of having a stricture and were traumatized by dilatations with sounds. Results were bad. Zone C includes the posterior urethra (membranous and prostatic). In addition to urothelial andlor squamous tumors there were other neoplasms in this zone which were from paraprostatic structures, such as the terminals of the prostatic ductules, the meatus of the ejaculatory ducts, and the utricle. Urothelial or squamous cell cancers sometimes invaded the prostate and were erroneously diagnosed in some instances as primary neoplasms, in spite of the absence of microacinar patterns in the histology, nonelevation of the serum acid phosphatase, and osseous metastases which were lytic. Failure to recognize the epithelial character of these lesions and that they are not hormonally dependent led to operative procedures and administration of estrogens which adversely affected the underlying process.