Urachal carcinoma: Report of two cases and review of the literature

Abstract

Abstract. Urachal carcinoma is a rare tumor that most commonly occurs in ovaries and less often in the adnexal region and urinary system. We herein present two cases of urachal carcinoma: One case was a 32-year-old male patient who presented with painless hematuria with blood clots for 1 month, whereas the other case was a 50-year-old woman who presented with gross hematuria with mild dysuria, urgency and frequent urination for 1 year. Following surgical resection, the two patients were diagnosed with urachal adenocarcinoma (mixed type) and urachal mucinous adenocarcinoma, respectively, based on the histopathological examination. A review of previously published cases and relevant literature is also presented. The aim of the present study was to help understand this disease better, in order to reduce the rate of clinical and pathological misdiagnosis. IntroductionUrachal carcinoma is a rare non-urothelial carcinoma, accounting for 0.01% of all malignancies and for 0.17-0.34% of all bladder tumors (1,2). Urachal carcinoma is more common among men, and the majority of the patients are aged >50 years (3). Although hematuria is the most common symptom, the disease is usually advanced when this symptom appears (4). As urachal carcinoma frequently invades the bladder at the dome or elsewhere along its midline, which is not easily detected during the early stages, it is often discovered late (5). Furthermore, there is currently no effective treatment for urachal carcinoma, leading to a poor prognosis. We herein report the cases of two patients with urachal carcinoma and urachal mucinous carcinoma. The relevant literature was also reviewed in order to help improve the diagnosis and treatment of this rare disease. Case reportsCase 1. The patient was a 32-year-old man who noted painless hematuria with blood clots for 1 month. There were no obvious precipitating or alleviating factors. On physical examination, there were no positive physical findings and the patient experienced no other discomfort. The results of the laboratory and imaging examinations (hemogram, urinalysis, prothrombin time, activated partial thromboplastin time, liver and kidney function tests and chest X-ray) were normal. However, urinary tract ultrasonography revealed an abnormal mixed signal at the bottom of the bladder. On further cystoscopy, only a small blood clot was detected. However, computed tomography (CT) revealed a circular hypodense mass located at the top and anterior part of the bladder, sized ~44x43 mm, without enlarged lymph nodes or other sign of metastatic disease (Fig. 1A).Following the doctors' recommendation, the patient consented to radical resection of the urachal tumor and partial cystectomy in August, 2015. We found that the lower part of the tumor was connected to the anterior wall of the bladder, whereas the upper part of the tumor was connected with the umbilical region. The tumor was sized ~7x8 cm. On gross pathological examination, the resected specimen was grey-yellow and gray-red, with a diameter of 6 cm. A small area co...

Carcinoma de uraco, una neoplasia maligna poco frecuente

“…Morfológicamente, el 90% son adenocarcinomas (4) , presentando cinco subtipos histopatológicos: células intestinales (50%), mucinoso, en anillo de sello, mixto y adenocarcinoma no especificado (5) .…”

“…La tomografía computada (TC) es la imagen más empleada, reportando hallazgos característicos como la presencia de masa supravesical anterior a la línea media y calcificaciones periféricas (5) . La RNM permite ampliar el compromiso tumoral al encontrarse una masa sólida o quísti-ca heterogénea en el trayecto del uraco con calcificaciones y ganglios linfáticos aumentados de tamaño (7) .…”

“…Se constituye de tres capas: una externa constituida por músculo liso, una intermedia constituida por tejido conectivo submucosa y una interna de tipo luminal. De las anteriores, las células epiteliales que constituyen cada capa dan lugar al carcinoma de uraco (5) . …”

Robot-assisted laparoscopic intracorporeal urachal mass resection and partial cystectomy for a huge urachal adenocarcinoma: a case report and review of literature

“…However, urachal remnants with epithelial-lined tubular or cystic muscle structures are found in approximately a third of adults. It is usually found in the dome of the urinary bladder and along the midline of the bladder wall [1,3].…”

Resección laparoscópica de adenocarcinoma de uraco

“…La extensión cefálica del seno urogenital, que es el precursor de la vejiga fetal se comunica con el alantoides, el cual es derivado del saco vitelino, a nivel del ombligo 1 . Esta estructura se constituye de tres capas las cuales son: una externa constituida por músculo liso, la intermedia que está constituida por tejido conectivo submucoso y la interna que es de tipo luminal, las células epiteliales que constituyen estas capas dan lugar a los tumores como el adenocarcinoma de uraco, 2 se sabe que justo antes del nacimiento este conducto queda totalmente obliterado y que se convertirá en un cordón fibroso en el adulto, conocido como ligamento umbilical medio 3 .…”