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Primary Small Cell Neuroendocrine Tumor Within a Urethral Diverticulum. BACKGROUND: Primary small cell neuroendocrine carcinoma of the urinary tract is a very rare cancer, accounting for fewer than 0.5% of urinary tract tumors. These are aggressive neoplasms with high rates of metastases. Urethral diverticula can be found in up to 6% of women. CASE: A 31-year-old woman presented with a clear vaginal discharge and an anterior vaginal wall mass that was thought to be a recurrent cyst. After surgical dissection, she was noted to have a urethral diverticulum with a solid nodule at the base. Final pathology showed a high-grade small cell neuroendocrine carcinoma. CONCLUSION: Malignancy in a urethral diverticulum can occur in young patients. Clinicians should be aware of this possibility when choosing to manage urethral lesions expectantly.