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CASE REPORT Table of Contents   
Year : 2002  |  Volume : 12  |  Issue : 1  |  Page : 89-90
Case report : Urachal adenocarcinoma


Deptt. of Imaging Sciences, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai, 625107, India

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Keywords: Calculi, Continent urinary diversion, Indiana pouch

How to cite this article:
Rajapandian I, Mukuntharajan T, Pawar P, Kondeti R, Jeyaraman A. Case report : Urachal adenocarcinoma. Indian J Radiol Imaging 2002;12:89-90

How to cite this URL:
Rajapandian I, Mukuntharajan T, Pawar P, Kondeti R, Jeyaraman A. Case report : Urachal adenocarcinoma. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Jun 20];12:89-90. Available from: http://www.ijri.org/text.asp?2002/12/1/89/28426
Urachal adenocarcinoma is a rare tumour from the urachus-vestigial remnant of cloaca within space of Retzius.

We report a case of urachal adenocarcinoma.


   Case report Top


A 50 years old male presented with dull aching lower abdominal pain and single episode of haematuria.

He underwent plain Radiograph, US, CT, cystoscopy and biopsy followed by surgery.

Plain Radiograph revealed - no evidence of calcification.

Ultrasound - longitudinal section revealed an elliptical, predominantly hypoechoic mass with focal hyperechoic areas within it, arising from the anterosuperior surface of the bladder in the midline [Figure - 1]

Contrast enhanced spiral CT showed a moderately enhancing mixed density mass with small punctuate calcifications at the anterosuperior wall of the bladder in midline with large supra vesical component in the space of Retzius. The fat plane between the mass lesion and the anterior abdominal wall is preserved. [Figure - 2]

There was no evidence of regional lymphadenopathy or metastases.

Cystoscopy and biopsy performed subsequently showed a trabeculated growth protruding from the fundus of the bladder with ulceration of the bladder mucosa.

Histopathology revealed adenocarcinoma probably urachal.

At Surgery, Partial cystectomy was done and the tumour with 5cm of surrounding normal bladder wall was removed along with the umbilicus & infra - umbilical part of the abdominal wall [Figure - 3]


   Discussion Top


Urachal carcinoma constitutes 0.2 - 0.34 % of all bladder cancers & 20-40% of all primary bladder adenocarcinomas.


   Histology Top


  1. 84% of urachal carcinomas are adenocarcinomas from malignant transformation of columnar metaplasia, 75% of them are mucin producing.
  2. 3% are Transitional cell carcinomas, rarely sarcoma & squamous cell carcinoma can also occur.
  3. 75% of urachal neoplasms in patients less than 29 years of age are Sarcomas.


Clinical features: It commonly occurs in 5th to 7th decade & is 3 times more common in males.

Patients usually present with a suprapubic mass, abdominal pain, haematuria (71%), discharge of blood/pus/mucus from umbilicus, irritative voiding symptoms & mucous micturition (25%).

Staging:

I - Cancer limited to the urachus.

II - Invasion limited to the urachus.

IIIA- Local invasion of bladder.

IIIB - Invasion of abdominal wall.

IIIC - Invasion of peritoneum.

IIID - Invasion of other visera

IVA - Metastases to local lymph nodes.

IVB - Distant metastases.

Location:

Supravesical, Midline anterior (80%) in space of Retzius ( bounded by transversalis fascia ventrally & peritoneum dorsally)

Specific features:

  • Mass anterosuperior to vesical dome with predominantly muscular or Extravesical involvement.
  • Invasion of bladder dome (88%)
  • Low attenuation mass in 60% (due to mucin)
  • Often peripheral psammomatous pathognomonic calcifications (70%)
  • On MRI, markedly increased signal intensity on T2 W images
  • Prognosis - 7-16% 5 years survival rate[5].


 
   References Top

1.Gerald W> Friedland, Pieter A devries, Matilde Nino- Murcia-congenital Anomalies of Urachus & bladder in clinical urography-2nd edition Philadelphia- W B saunders Howard M Pollack 2000 pg. No 829-831.  Back to cited text no. 1    
2.Wolfgang Dahnert- Radiolgy Review Manual- 4th ed.- 1999- pg. 814- Philadelphia- Lipppincott- Raven, William & Wilkins.  Back to cited text no. 2    
3.Brick SH, Freidman AC, Pollack HM, et al: Urachal carcinoma CT findings. Radiology 1988 Nov, 169 (2): pg. 377-81.  Back to cited text no. 3    
4.Narumi Y, Sato T, Kuriyama K, et al: vesical dome tumours: significances Of extravesical extension on CT. Radiolgy 1988 Nov; pg. 383-385.  Back to cited text no. 4    
5.Sheldon CA, Clayman RV, Gonzalez R, et al: Malignant urachal lesions. J Urol 11984 Jan, 131 (1): Pg. 1-8  Back to cited text no. 5    

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Correspondence Address:
I Rajapandian
Deptt. of Imaging Sciences, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai, 625107
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

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