Diagnostic Considerations

Urethral prolapse is similar in appearance to urethral caruncle, but is circumferential while caruncles are focal. Urethral prolapse may occur in prepubescent girls or postmenopausal women, whereas caruncles are seen almost exclusively in the latter.

Reports of neoplastic lesions mimicking urethral caruncles include the following:

Condyloma acuminatum ^[9]
Primary malignant melanoma of the urethra ^{[4, 10]}
Urethral lymphoma ^[11] ^[12]

Intraepithelial squamous cell carcinoma arising within a urethral caruncle has been reported in two patients.^[13]

Urethral leiomyoma masquerading as urethral caruncle have been reported.^[14] In addition, urethral caruncles may contain atypical stromal cells, and these pseudoneoplastic lesions must be differentiated from lymphoma or sarcoma.^[15]

Cases of urethral tuberculosis^{[16, 17]} and periurethral colonic-type polyp resembling urethral caruncle have rarely been reported.^{[18, 19]}

A rare case of extramedullary plasmacytoma (EMP) initially diagnosed as a urethral caruncle has been reported.^[20]

Differential Diagnoses

Workup

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Karthikeyan K, Kaviarasan PK, Thappa DM. Urethral caruncle in a male: a case report. J Eur Acad Dermatol Venereol. 2002 Jan. 16(1):72-3. [QxMD MEDLINE Link].
Gamage M, Beneragama D. Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl. Case Rep Pediatr. 2018. 2018:3486032. [QxMD MEDLINE Link]. [Full Text].
Bansal N, Garg G, Vashist S. Primary malignant melanoma of urethra mimicking as urethral caruncle. BMJ Case Rep. 2018 Jul 30. 2018:[QxMD MEDLINE Link].
Chiba M, Toki A, Sugiyama A, Suganuma R, Osawa S, Ishii R, et al. Urethral caruncle in a 9-year-old girl: a case report and review of the literature. J Med Case Rep. 2015 Mar 28. 9:71. [QxMD MEDLINE Link]. [Full Text].
Sonoda K, Kato R, Kojima H, Tokuda Y. Urinary tract bleeding from a urethral caruncle mimicking genital tract bleeding. BMJ Case Rep. 2019 Feb 25. 12 (2):[QxMD MEDLINE Link]. [Full Text].
Ozkurkcugil C, Ozkan L, Tarcan T. The effect of asymptomatic urethral caruncle on micturition in women with urinary incontinence. Korean J Urol. 2010 Apr. 51(4):257-9. [QxMD MEDLINE Link]. [Full Text].
Coban S, Bıyık I. Urethral caruncle: Case report of a rare acute urinary retension cause. Can Urol Assoc J. 2014 Mar. 8 (3-4):E270-2. [QxMD MEDLINE Link]. [Full Text].
Cheng N, Kirkpatrick G, Fromer DL. Female urethral condyloma acuminata mimicking urethral caruncle. Can J Urol. 2020 Aug. 27 (4):10336-10338. [QxMD MEDLINE Link].
Nakamoto T, Inoue Y, Ueki T, Niimi N, Iwasaki Y. Primary amelanotic malignant melanoma of the female urethra. Int J Urol. 2007 Feb. 14(2):153-5. [QxMD MEDLINE Link].
Chen YR, Hung LY, Chang KC. Mucosa-associated lymphoid tissue-type lymphoma presenting as a urethral caruncle with urinary bladder involvement. Int J Urol. 2014 Oct. 21 (10):1073-4. [QxMD MEDLINE Link]. [Full Text].
Palmisano F, Lorusso V, Spinelli MG, Dell'Orto PG, Montanari E. Blastoid variant of mantle cell lymphoma of the female urethra mimicking a caruncle: A rare but highly aggressive subtype case with literature review. Arch Ital Urol Androl. 2019 Mar 29. 91 (1):49-50. [QxMD MEDLINE Link].
Kaneko G, Nishimoto K, Ogata K, Uchida A. A case of intraepithelial squamous cell carcinoma arising from urethral caruncle. Can Urol Assoc J. 2011 Feb. 5(1):E14-6. [QxMD MEDLINE Link]. [Full Text].
Saroha V, Dhingra KK, Gupta P, Khurana N. Urethral leiomyoma mimicking a caruncle. Taiwan J Obstet Gynecol. 2010 Dec. 49(4):523-4. [QxMD MEDLINE Link].
Young RH, Oliva E, Garcia JA, Bhan AK, Clement PB. Urethral caruncle with atypical stromal cells simulating lymphoma or sarcoma--a distinctive pseudoneoplastic lesion of females. A report of six cases. Am J Surg Pathol. 1996 Oct. 20(10):1190-5. [QxMD MEDLINE Link].
Indudhara R, Vaidyanathan S, Radotra BD. Urethral tuberculosis. Urol Int. 1992. 48(4):436-8. [QxMD MEDLINE Link].
Singh I, Hemal AK. Primary urethral tuberculosis masquerading as a urethral caruncle: a diagnostic curiosity!. Int Urol Nephrol. 2002. 34(1):101-3. [QxMD MEDLINE Link].
Willett GD, Lack EE. Periurethral colonic-type polyp simulating urethral caruncle. A case report. J Reprod Med. 1990 Nov. 35 (11):1017-8. [QxMD MEDLINE Link].
Raspollini MR, Nicita G, Mikuz G. Polypoid intestinal metaplasia of the external urethral meatus. Int J Surg Pathol. 2012 Dec. 20 (6):640-2. [QxMD MEDLINE Link].
Su W, Zeng L, Zhao D, Fu Y, Tang J. Case Report: Plasmacytoma of External Urethral Meatus. Front Endocrinol (Lausanne). 2022. 13:783855. [QxMD MEDLINE Link]. [Full Text].
Wang X, Lei J, Zhang W, Zhou J, Song L, Ying T. The ultrasonographic characteristics of female periurethral solid masses. Int Urogynecol J. 2022 Mar. 33 (3):605-612. [QxMD MEDLINE Link].
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Verma V, Pradhan A. Management of urethral caruncle - A systematic review of the current literature. Eur J Obstet Gynecol Reprod Biol. 2020 May. 248:5-8. [QxMD MEDLINE Link].
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Martin FM, Rowland RG. Urologic malignancies in pregnancy. Urol Clin North Am. 2007 Feb. 34(1):53-9. [QxMD MEDLINE Link].
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Rovner ES. Bladder and Female Urethral Diverticula. Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016. Vol 3: 2140-68.

Media Gallery

This image shows marked vascular engorgement and a polymorphous inflammatory infiltrate in the stroma. Surface epithelium is benign. Courtesy of GT MacLennan, MD.
Photographs show the preoperative (a) and postoperative (b) appearance of a urethral caruncle in a 9-year-old girl. Courtesy of Journal of Medical Case Reports, Springer Nature.

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Author

Kamran P Sajadi, MD Associate Professor, Departments of Urology and Obstetrics and Gynecology, Oregon Health and Science University School of Medicine

Kamran P Sajadi, MD is a member of the following medical societies: American Urogynecologic Society, American Urological Association, Endourological Society, Oregon Medical Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, Western Section of the American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, The Scientific Research Honor Society, Society of University Urologists, SWOG

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Allen Donald Seftel, MD Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel, MD is a member of the following medical societies: American Urological Association

Disclosure: Received consulting fee from lilly for consulting; Received consulting fee from abbott for consulting; Received consulting fee from auxilium for consulting; Received consulting fee from actient for consulting; Received honoraria from journal of urology for board membership; Received consulting fee from endo for consulting.

Acknowledgements

Ann Y Becker, MD Assistant Professor, Section of Urology, Medical College of Georgia

Ann Y Becker, MD is a member of the following medical societies: American Medical Women's Association, American Urological Association, and Society of Women in Urology

Disclosure: Nothing to disclose.

Scott Rutchik, MD Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine

Scott Rutchik, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Urethral Caruncle Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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