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Yan J, Li H, Yan G, Duan Q, Tang C, McClure MA, Bhetuwal A, Li Y, Yang L, Li R, Tan G, Feng B. Primary urachal leiomyosarcoma: a case report and literature review of clinical, pathological, and medical imaging features. Front Oncol 2023; 13:1228178. [PMID: 37664058 PMCID: PMC10470618 DOI: 10.3389/fonc.2023.1228178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Urachal tumors are exceedingly rare, and adenocarcinoma is the most common malignant urachal neoplasm. Here, an especially rare patient of primary urachal leiomyosarcoma from our hospital was reported, and only five patients have been reported thus far since 1981. Case description A 24-year-old man was admitted due to urinary tract symptoms. Both urogenital ultrasonography and contrast-enhanced computed tomography showed a mass at the dome of the urinary bladder. Laparoscopic surgical resection was performed, and histopathologic examination of the mass confirmed the diagnosis of urachal leiomyosarcoma. No recurrence was noted after one and a half years. Conclusions Because the leiomyosarcoma located in the extraperitoneal space of Retzius and may manifest with nonspecific abdominal or urinary symptoms, early and definitive preoperative diagnosis is challenging. Partial cystectomy with complete excision of the urachus is recommended. Because only a few patients have been recorded, clinical outcomes and recurrence risks are difficult to assess.
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Affiliation(s)
- Jing Yan
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Hongwei Li
- Department of Radiology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Gaowu Yan
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Qing Duan
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Chunyan Tang
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Morgan A. McClure
- Department of Radiology and Imaging, Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Ling Yang
- Department of Pathology, Suining Central Hospital, Suining, China
| | - Ruyi Li
- Department of Radiology, Lixian People’s Hospital, Aba, China
| | - Gangcheng Tan
- Department of Radiology, Lixian People’s Hospital, Aba, China
| | - Bo Feng
- Department of Radiology, Lixian People’s Hospital, Aba, China
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Abstract
Urachal anomalies are classified into four types depending on the level of persistence of the embryonic urachal remnants between the urinary bladder and the umbilicus: patent urachus, umbilical-urachal sinus, urachal cyst, and vesico-urachal diverticulum. Due to the increasing use of cross-sectional imaging, urachal anomalies are frequently detected as incidental findings. Imaging plays a pivotal role in the initial diagnosis, evaluation of complications, treatment follow-up, and long-term surveillance of patients with urachal anomalies. Different urachal anomalies demonstrate characteristic imaging features that aid in a timely diagnosis and guide treatment. A patent urachus is visualized as an elongated tubular structure between the umbilicus and the urinary bladder. While umbilical-urachal sinus appears as focal dilatation at the umbilical end of the urachal remnant, the vesico-urachal diverticulum presents as a focal outpouching of the urinary bladder at anterosuperior aspect. Urachal cysts are identified as midline fluid-filled sacs most frequently located near the dome of the urinary bladder. Untreated urachal anomalies could progress into potential complications, including infection and malignancy. Knowledge regarding imaging features of urachal anomalies helps in timely diagnosis, treatment, follow-up, and early detection of complications.
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Lam SW, Linsen PVM, Elgersma OE. Infection of Previously Closed Urachus Mimicking Malignancy: A Case Report and Literature Review of Radiological Findings to the Diagnosis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619843836. [PMID: 31037039 PMCID: PMC6475833 DOI: 10.1177/1179547619843836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 01/17/2023]
Abstract
The urachus is a vestigial structure of the allantois and cloaca. It involutes as fetal development progresses to become a fibrous cord, which courses between the umbilicus and bladder dome within the retropubic space. Infection occasionally occurs in patients with congenital patent urachus. Here, we report a patient with infection of a previously closed urachal tract presenting as an abdominal mass. This has rarely been described in the literature. Current knowledge on imaging findings to the diagnosis is discussed.
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Affiliation(s)
- Siu W Lam
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Siu W Lam, Department of Radiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, Dordrecht 3318AT, The Netherlands.
| | - Philip VM Linsen
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Otto E Elgersma
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Reis H, Krafft U, Niedworok C, Módos O, Herold T, Behrendt M, Al-Ahmadie H, Hadaschik B, Nyirady P, Szarvas T. Biomarkers in Urachal Cancer and Adenocarcinomas in the Bladder: A Comprehensive Review Supplemented by Own Data. DISEASE MARKERS 2018; 2018:7308168. [PMID: 29721106 PMCID: PMC5867586 DOI: 10.1155/2018/7308168] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/06/2018] [Indexed: 12/11/2022]
Abstract
Urachal cancer (UrC) is a rare but aggressive cancer. Due to overlapping histomorphology, discrimination of urachal from primary bladder adenocarcinomas (PBAC) and adenocarcinomas secondarily involving the bladder (particularly colorectal adenocarcinomas, CRC) can be challenging. Therefore, we aimed to give an overview of helpful (immunohistochemical) biomarkers and clinicopathological factors in addition to survival analyses and included institutional data from 12 urachal adenocarcinomas. A PubMed search yielded 319 suitable studies since 1930 in the English literature with 1984 cases of UrC including 1834 adenocarcinomas (92%) and 150 nonadenocarcinomas (8%). UrC was more common in men (63%), showed a median age at diagnosis of 50.8 years and a median tumor size of 6.0 cm. No associations were noted for overall survival and progression-free survival (PFS) and clinicopathological factors beside a favorable PFS in male patients (p = 0.047). The immunohistochemical markers found to be potentially helpful in the differential diagnostic situation are AMACR and CK34βE12 (UrC versus CRC and PBAC), CK7, β-Catenin and CD15 (UrC and PBAC versus CRC), and CEA and GATA3 (UrC and CRC versus PBAC). Serum markers like CEA, CA19-9 and CA125 might additionally be useful in the follow-up and monitoring of UrC.
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Affiliation(s)
- Henning Reis
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Christian Niedworok
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Orsolya Módos
- Department of Urology, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
| | - Thomas Herold
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Mark Behrendt
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
- Department of Urology, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
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Hartman R, Kawashima A. Lower tract neoplasm: Update of imaging evaluation. Eur J Radiol 2017; 97:119-130. [PMID: 29102424 DOI: 10.1016/j.ejrad.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/13/2023]
Abstract
Cancers of the lower urinary tract can arise from the bladder, urachus or urethra. Urothelial carcinoma of the bladder (UCB) is the most common of these. The presentation of bladder, urachal and urethral cancers can differ but many result in hematuria as an initial indication. The diagnosis and staging of these cancers often necessitate radiologic imaging often in the form of cross-section CT urography or MR urography. The following article reviews the specific nature of lower tract cancers and their imaging.
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Affiliation(s)
- Robert Hartman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH. Imaging of the Urachus: Anomalies, Complications, and Mimics. Radiographics 2016; 36:2049-2063. [DOI: 10.1148/rg.2016160062] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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A rare cause of urachal adenocarcinoma: urachal diverticle. Case Rep Urol 2013; 2013:571395. [PMID: 23476880 PMCID: PMC3580940 DOI: 10.1155/2013/571395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/04/2013] [Indexed: 11/17/2022] Open
Abstract
Urachus is the remnant of the embryologic allantois and the fetal bladder, extending form the bladder roof to the umbilicus. It degenerates in the prenatal period into a tissue band known as the median umbilical ligament. Incomplete degeneration may lead to urachal diverticle development. It is difficult to diagnose unless it is considered in differential diagnosis and imaging modalities are employed. This paper describes a patient treated with partial cystectomy for urachal diverticle, and the pathologic examination revealed urachal adenocarcinoma.
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Zhang J, Wu J. Options for diagnosis and treatment of urachal carcinoma. Asia Pac J Clin Oncol 2012; 9:117-22. [PMID: 23046343 DOI: 10.1111/j.1743-7563.2012.01592.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 12/29/2022]
Abstract
Urachal carcinoma (UrC) is a rare but highly malignant epithelial cancer and commonly found in the urachal remnant which connects the dome of the bladder to the umbilicus via the ligamentum commune. Because of the specificity of the tumor location and its rarity, the diagnosis of UrC is often difficult. Although surgery is the treatment of choice for UrC, it still has a high incidence of local recurrence and distant metastasis and there are few modestly standard chemotherapy regimens for these patients (response rate 30-40%). Thus, the treatment of local recurrence and distant metastasis of UrC following surgery has been a challenge. We review the clinical diagnosis and therapy of UrC and factors related to its prognosis.
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Affiliation(s)
- Jianwen Zhang
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Luzhou, China.
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