Primary urethral carcinomas are rare in women, but are more common than in men in most series (Fig. 46A and B) (89,90). They tend to occur in postmenopausal women (90). While potentially curable if of low stage, the vagueness of early symptomatology may lead to late diagnosis and poor outcome (91). Distal urethral neoplasms are more likely to be diagnosed at an earlier stage than proximal ones. Histology is variable, and carcinomas may be squamous cell, adenocarcinoma, ade-nosquamous carcinoma, transitional cell, or undifferentiated carcinoma, reflecting the variability of the lining cells in the female urethra. Carcinoma can arise in a urethral diverticulum (92), and these may be clear cell adenocarcinomas (90). Distal carcinomas tend to be squamous cell carcinomas, while proximal lesions are more likely either transitional or adenocarcinoma (90). Rare adenocarcinomas with enteric differentiation have also been described (Table 46) (93).
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