Clinical and Radiological Features of Urachal Carcinoma and Infection

Abstract

PurposeTo explore the clinical and radiological differences between urachal carcinoma and urachal infection.MethodsClinical and imaging information for 13 cases of urachal carcinoma and 14 cases of urachal infection confirmed by pathology were retrospectively analyzed. The size, location, shape, margin, lesion composition, calcification, T1 and T2 signal intensity, peripheral lymph nodes, degree of enhancement, adjacent bladder wall, and apparent diffusion coefficient (ADC) value were examined in both groups, and distinguish features were determined. The student t-test or Mann-Whitney U test was used for quantitative data, and Fisher’s exact test was used for qualitative data. Kappa coefficient consistency test was used to evaluate the interobserver agreement.ResultsSex, hematuria, abdominal pain, calcification, and thickening of adjacent bladder wall can distinguish between urachal carcinoma and urachal infection (p < 0.05). There were no statistical differences in age (p = 0.076), size (p = 0.797), location (p = 0.440), shape (p = 0.449), margin (p = 0.449), lesion composition (p = 0.459), T1 signal intensity (p = 0.196), T2 signal intensity (p = 0.555), peripheral lymph nodes (p = 0.236), degree of enhancements (p = 0.184) and ADC value (p = 0.780) between two groups.ConclusionThe following clinical and imaging features help distinguish urachal carcinoma from urachal infection: sex, hematuria, abdominal pain, calcification, and thickening of the adjacent bladder wall.

Urachal Carcinoma, An Unusual Possibility of Hematuria; Case Report and Literature Review

“…Infection of the urachal remnants may mimic urachal carcinoma, resulting in challenges for imaging diagnosis; therefore, in unclear cases, biopsies are recommended. In general, hematuria and calcification are more likely to be urachal carcinoma, while in the female gender, abdominal pain and thickening of adjacent bladder wall are more likely to be infections [ 11 ]. Additionally the typical extension of urachal carcinomas along the Retzius space helps differentiate them from vesical carcinomas [ 29 ].…”

“…Non-glandular neoplasms can be urothelial, squamous cells, neuroendocrine, and mixed type [ 9 ]. Urachal carcinoma affects patients between 40 and 70 years of age, with a male predilection (male: female = 12:1) [ 10 , 11 ].…”

Preoperative accuracy of diagnostic evaluation of urachal carcinoma

“… 4 , 5 Urachal carcinoma (UrC) is an extremely rare and aggressive tumor originating from the urachus, with an annual incidence of about 1/5,000,000, accounting for 0.34% of bladder cancer. 6 , 7 , 8 The median age of onset is 50–60 years old, and the most common histological type is adenocarcinoma (which can be divided into mucinous, enteric, and signet ring cell types), with urothelial carcinoma, neuroendocrine carcinoma, sarcoma, squamous cell carcinoma being uncommon. 9 , 10 , 11 , 12 Tumors are found throughout the urachus course in the Retzius space, with 90% located at the urachus junction, 6% in the middle, and 4% in the upper part of the urachus.…”

“…Compared with CT, MRI has no ionizing radiation and allows for more visualization of the anatomy. 6 , 19 Cystoscopy and biopsy of the bladder have high sensitivity and specificity, but this method has high medical costs and large trauma, and can only be used for patients with stage III (referring to Sheldon staging for UrC) and above. For patients with stage I and II, the effect is not effective, because early UrC is confined to the urachus and has not infringed the bladder, thus increasing the difficulty of the diagnosis of UrC.…”

Isolated urachal tuberculosis: a rare culprit of abdominal pain and frequent urination

“…Infected urachal remnant is frequently misdiagnosed as malignancy. Hematuria and calcification can be used as features of urachal carcinoma to differentiate it from infected urachal lesions [4]. For individuals with recurrent or intractable urinary tract infections, tuberculosis should be suspected.…”