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Clitoromegaly Caused by Metastatic Carcinosarcoma of the Urinary Bladder

2003; American Medical Association; Volume: 127; Issue: 4 Linguagem: Inglês

10.5858/2003-127-0505-ccbmco

1543-2165

Peter Langenstroer, Maria Romanas, Ivan Damjanov,

Urologic and reproductive health conditions

A 69-year-old woman was found to have a carcinosarcoma of the urinary bladder that was considered to be inoperable. Two weeks after the initial biopsy was performed, the patient developed painful swelling of the clitoris. Gynecologic examination revealed an enlarged clitoris, measuring 2 × 2.5 × 1.5 cm. The clitoris was firm and very sensitive to palpation. The following week, the patient underwent a palliative anterior pelvic exenteration of the urinary bladder with urinary diversion and partial vulvectomy involving the upper part of the vulva and clitoris. Postoperatively, the patient has done well and is undergoing further systemic treatment for this malignancy.Pathologic examination of the urinary bladder revealed a carcinosarcoma measuring 20 × 15 × 14 cm; the lesion almost completely filled the urinary bladder and penetrated through its anterior wall. The vulvectomy specimen contained an enlarged clitoris. As shown in Figure 1, representing the whole-mount of the clitoris, the entire organ was infiltrated with tumor cells. The tumor cells were spindle shaped, corresponding to the sarcomatous component of the urinary bladder tumor (Figures 2 and 3). Scattered nests of carcinoma were focally demonstrable immunohistochemically with antibodies to keratin (not shown).Primary and secondary clitoral tumors are very rare. Our review of the medical literature revealed only 4 cases of metastatic disease to the clitoris, 2 from primary gastrointestinal tract carcinomas and 2 from primary transitional cell carcinomas of the urinary bladder.12 To the best of our knowledge, this is the first case of a urinary bladder carcinosarcoma metastatic to the clitoris, increasing to 5 cases the total number of reported clitoral metastases.Clitoromegaly is most often caused by hormonal disturbances.3 Such hormonal clitoromegaly should be distinguished from neoplastic clitoral enlargement, which is extremely rare. Clitoromegaly caused by metastases is even less common. The reasons for the rarity of clitoral metastases are unclear, but several possible explanations come to mind, such as the small size of the clitoris, its peripheral location, and its unique blood supply.