Urethral metastasis: an uncommon presentation of a colonic adenocarcinoma.

INTRODUCTION: Metastases to the urethra are a rare clinical entity. To our knowledge there are less than ten case reports described in the literature. In this report, however we describe a case of urethral metastases from a colonic cancer origin where the urethral lesion was the presenting symptom. CASE REPORT: A 69-year-old woman presented with a swelling at the urethral opening. Per vaginal examination revealed a hard tender lesion situated at the external urethral meatus with contact bleeding. Excision biopsy revealed adenocarcinoma. Immunohistochemical staining demonstrated that the tumour cells were strongly suggestive of a metastatic lesion from the colon. Subsequent investigations revealed that the patient did indeed have a sigmoid adenocarcinoma and underwent chemotherapy with a view to anterior resection and pelvic exenteration. DISCUSSION: Metastases to the urethra are rare. Treatment options have to be individualised to the extent of the disease and the symptoms of the patient. Immunohistochemical staining can help to a certain extent to point the direction towards the possible primary lesion. Atypical presentations of urethral lesions should be viewed with suspicion. A biopsy of the lesion is the only way of confirming diagnosis.