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Urachal adenocarcinoma: a rare case report

View Article: PubMed Central - PubMed

ABSTRACT

Urachal carcinoma is a rare and aggressive form of bladder cancer involving the urachus, a fibrous remnant of the allantois that extends from the bladder to the umbilicus. We report this case of a 49-year-old women with primary urachal adenocarcinoma treated with partial cystectomy who relapsed 5 years after surgery with lung metastases. This patient with unremarkable medical history presented with abdominal discomfort and a palpable pelvic mass. Follow-up imaging reveals a large mass on the dome of the bladder extending from the urachus. Subsequent ultrasound-guided biopsy result was suggestive of an urachal mucinous adenocarcinoma. The patient was treated surgically with a partial cystectomy.

No MeSH data available.


(A) Transabdominal ultrasound scan of the pelvis shows heterogeneous mass measuring 4.7 cm by 9 cm inseparable from the urinary bladder. (B) Transabdominal ultrasound scan of the pelvis showing heterogenous mass with internal vascular flow arrows.
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fig1: (A) Transabdominal ultrasound scan of the pelvis shows heterogeneous mass measuring 4.7 cm by 9 cm inseparable from the urinary bladder. (B) Transabdominal ultrasound scan of the pelvis showing heterogenous mass with internal vascular flow arrows.

Mentions: Imaging of the abdomen was ordered to further assess the mass. Initial ultrasound (US) examination revealed a 15-cm mass localized to the dome of the urinary bladder (Figs. 1A and B). Subsequent magnetic resonance imaging (MRI) scan confirmed a mass measuring 14 × 8.5 × 7.3 cm arising from the left lower rectus abdominis muscle (Fig. 2, Fig. 3, Fig. 4). It extends anteriorly into the subcutaneous tissue and posteriorly imparts significant mass effect on the dome of the bladder. Contrast-enhanced computed tomography (CT) scan of the abdomen also confirms an enhancing mass lesion on the wall of the urinary bladder (Fig. 5). Given the imaging findings, the differential diagnosis at the time included: soft tissue sarcoma, dermatofibrosarcoma protuberans, and desmoid tumor. The patient underwent a cystoscopy, which detected the presence of a submucosal bulge at the urinary bladder dome in the expected area of the residual urachus, consistent with large urachal adenocarcinoma. An US-guided biopsy of the cystic mass showed significant histologic findings indicative of low grade mucinous adenocarcinoma. Colonoscopy at the time did not reveal evidence of primary cancer involving the colon. Also, CT scan of chest, abdomen, and pelvis in addition to positron emission tomography (PET) scan did not reveal regional nor distant metastasis at the time.


Urachal adenocarcinoma: a rare case report
(A) Transabdominal ultrasound scan of the pelvis shows heterogeneous mass measuring 4.7 cm by 9 cm inseparable from the urinary bladder. (B) Transabdominal ultrasound scan of the pelvis showing heterogenous mass with internal vascular flow arrows.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5310256&req=5

fig1: (A) Transabdominal ultrasound scan of the pelvis shows heterogeneous mass measuring 4.7 cm by 9 cm inseparable from the urinary bladder. (B) Transabdominal ultrasound scan of the pelvis showing heterogenous mass with internal vascular flow arrows.
Mentions: Imaging of the abdomen was ordered to further assess the mass. Initial ultrasound (US) examination revealed a 15-cm mass localized to the dome of the urinary bladder (Figs. 1A and B). Subsequent magnetic resonance imaging (MRI) scan confirmed a mass measuring 14 × 8.5 × 7.3 cm arising from the left lower rectus abdominis muscle (Fig. 2, Fig. 3, Fig. 4). It extends anteriorly into the subcutaneous tissue and posteriorly imparts significant mass effect on the dome of the bladder. Contrast-enhanced computed tomography (CT) scan of the abdomen also confirms an enhancing mass lesion on the wall of the urinary bladder (Fig. 5). Given the imaging findings, the differential diagnosis at the time included: soft tissue sarcoma, dermatofibrosarcoma protuberans, and desmoid tumor. The patient underwent a cystoscopy, which detected the presence of a submucosal bulge at the urinary bladder dome in the expected area of the residual urachus, consistent with large urachal adenocarcinoma. An US-guided biopsy of the cystic mass showed significant histologic findings indicative of low grade mucinous adenocarcinoma. Colonoscopy at the time did not reveal evidence of primary cancer involving the colon. Also, CT scan of chest, abdomen, and pelvis in addition to positron emission tomography (PET) scan did not reveal regional nor distant metastasis at the time.

View Article: PubMed Central - PubMed

ABSTRACT

Urachal carcinoma is a rare and aggressive form of bladder cancer involving the urachus, a fibrous remnant of the allantois that extends from the bladder to the umbilicus. We report this case of a 49-year-old women with primary urachal adenocarcinoma treated with partial cystectomy who relapsed 5 years after surgery with lung metastases. This patient with unremarkable medical history presented with abdominal discomfort and a palpable pelvic mass. Follow-up imaging reveals a large mass on the dome of the bladder extending from the urachus. Subsequent ultrasound-guided biopsy result was suggestive of an urachal mucinous adenocarcinoma. The patient was treated surgically with a partial cystectomy.

No MeSH data available.