The Diagnostic Value of FDG-PET/CT for Urachal Cancer

A remnant never forgotten: the utility of circulating tumor DNA in treatment guidance of urachal cancer

Urachal cancer is a rare malignancy of the urachus that is treated with surgical resection if localized and systemic chemotherapy for metastatic disease. Circulating tumor DNA (ctDNA) is a single-stranded or double-stranded DNA released by tumor cells into the blood and harbored the mutations of the original tumor, shedding new light on molecular diagnosis and monitoring of cancer. We report a case of resected localized urachal cancer with clear surgical margins and negative lymph node dissection but elevated ctDNA that progressed to metastatic disease. We also highlight the possibility of using ctDNA levels to assist in adjuvant therapy.

Low-Grade Urachal Cystadenoma With Abundant Calcification Removed Using Robot-Assisted Laparoscopy: A Case Report

Neoplasms of the urachus are an extremely rare entity consisting of incompletely obliterated tissue of the urachal canal during embryonic development, which sometimes remains into adulthood in the urinary bladder. The treatment of choice for these entities is surgical excision, which maximizes patient survival should the lesion prove to be malignant. In this case, we describe a 57-year-old female who presented with a one-year history of left lower quadrant pain. The patient underwent robot-assisted surgery to remove the mass, bladder dome, and median longitudinal ligament en bloc without evidence of recurrence to date.

Clinical value of preoperative serum tumor markers CEA, CA19-9, CA125, and CA15-3 in surgically treated urachal cancer

INTRODUCTION

Urachal adenocarcinoma (UrAC) is a very rare malignancy with a poor prognosis. The role of preoperative serum tumor markers (STMs) in UrAC is unknown. The aim of this study was to assess the clinical value of elevated STMs including carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA125), and cancer antigen 15-3 (CA15-3) in surgically treated UrAC, and to evaluate their prognostic significance.

METHODS

This was a retrospective study of consecutive patients with histopathologically confirmed UrAC who underwent surgical treatment at a single tertiary hospital. Blood levels of CEA, CA19-9, CA125, and CA15-3 were determined before surgery. The proportion of patients with elevated STMs was calculated, as well as the association between elevated STMs and clinicopathological characteristics, recurrence-free survival and disease-specific survival.

RESULTS

Of the 50 patients included; CEA, CA 19-9, CA125, and CA15-3 were elevated in 40%, 25%, 26%, and 6% respectively. Elevated CEA was associated with higher pT-stage (odds ratio [OR] 3.3 [95% confidence interval 1.0-11.1], P = 0.003), higher Sheldon stage (OR 6.9 [95% CI 0.8-60.4], P = 0.01), male sex (OR 4.7 [95% CI 1.2-18.3], P = 0.01), and the presence of peritoneal metastases at the time of diagnosis (OR 3.5 [95% CI 0.9-14.2], P = 0.04). Elevated CA19-9 was associated with signet-cell component (OR 1.7 [95% CI 0.9-3.3], P = 0.03) and elevated CA125 was associated with peritoneal metastases at the time of diagnosis (OR 6.0 [95% CI 1.2-30.6], P = 0.04). Elevated STMs before surgery were not associated with recurrence-free survival and/or disease-specific survival.

CONCLUSION

A subset of patients with surgically treated UrAC has elevated STMs preoperatively. CEA was most frequently (40%) elevated and correlated with unfavorable tumor characteristics. However, STM levels did not correlate with prognostic outcomes.

Current Management of Urachal Carcinoma: An Evidence-based Guide for Clinical Practice

Urachal carcinoma is a rare urological disease. The shortage of data about diagnosis and surgical treatment in literature makes it hard for clinicians to make a decision. Indeed, urachal carcinoma is an aggressive disease that requires prompt staging and treatment to ensure the best outcome for patients. We reviewed the last evidence about the management of urachal carcinoma to provide an easy-to-use guide for clinical practice.

Patient summary

Urachal carcinoma is a rare malignancy. The literature on this challenging disease remains limited. Herein, we provide a practical guide for its management from diagnosis to treatment, which in most cases requires surgical intervention or chemotherapy.

Two Patients with Urachal Cancer with Multifocal Adenocarcinoma Recurrences in the Urothelium of the Prostatic and Penile Urethra

We report two cases with recurrences of urachal adenocarcinoma (UrAC) in the urethra. Both patients had mucinous UrAC without metastasis, for which they were treated with en-bloc partial cystectomy and umbilectomy. The first patient developed recurrence of UrAC in the distal urethra after 1 yr. Distal urethrectomy revealed multiple additional recurrences in the penile and prostatic urethra. The patient underwent radical cystoprostatectomy with en-bloc urethrectomy. At 5 mo after surgery, liver metastases were found. A search in our institutional database revealed a second patient who developed a solitary recurrence of UrAC in the prostatic urethra 8 yr after partial cystectomy. Radical cystoprostatectomy was performed. The patient subsequently experienced recurring UrAC in the urethra, which were treated with multiple surgeries and radiation. Unfortunately, local tumor control could not be achieved and the patient developed distant metastases 7 yr after cystoprostatectomy. Our two cases and four comparable cases reported in the literature indicate that urothelial spread of UrAC is rare but possible. It remains to be determined if UrAC spreads along the urothelium similar to urothelial cancer or if these multifocal urethral recurrences were the first sign of local metastasis.