Urachal signet-cell adenocarcinoma

Primary urachal signet ring cell carcinoma: A case report

Urachal signet ring cell carcinoma is a kind of rare but aggressive tumor, and a few cases have been reported previously. A 49-year-old male patient with primary complaints of increased frequency of urination, urodynia, and hematuria was diagnosed to have primary urachal signet ring cell carcinoma by our department. Multiple metastases were found in the sigmoid colon, terminal ileum, mesentery, and peritoneum during the operation, and palliative surgery involving partial cystectomy with en bloc resection of the urachus was then performed. A chemotherapy regimen of fluorouracil combined with cisplatin was made for this case. In addition, this patient also received anlotinib for targeted therapy. So far, this patient has done well on regular follow-up for 6 months and is in stable condition. We reported this additional urachal signet ring cell carcinoma case and conducted a literature review to strengthen our cognition of this disease.

Primary signet-ring cell carcinoma of the urinary bladder

Primary signet-ring cell carcinoma of the urinary bladder is a rare tumor. The overall incidence is approximately 0.12-0.6% of all urinary bladder malignancies. The majority of the patients present in an advanced stage with a uniformly grim prognosis. As signet-ring cell carcinomas are more common in the gastrointestinal tract, a possibility of metastasis needs to be considered. Here we report, a 42-year-old patient who presented with hematuria and was diagnosed with a urinary bladder tumor. The patient was managed with partial cystectomy and pelvic lymph node dissection. The histopathological examination confirmed primary signet-ring cell carcinoma of the urinary bladder.

Biomarkers in Urachal Cancer and Adenocarcinomas in the Bladder: A Comprehensive Review Supplemented by Own Data

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.

Options for diagnosis and treatment of urachal carcinoma

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.

Treatment of uncommon malignant tumours of the bladder

PURPOSE OF REVIEW

Urothelial carcinoma is the most common histological type of bladder tumours. Nevertheless, its variants and less common types represent 20% of all bladder cancers. The objective was to update the recent publications on these rare diseases and to draw conclusions for clinical management.

RECENT FINDINGS

Recent retrospective studies have been published. They refine the description of histological patterns and of immunochemistry diagnosis. Taking into account the heterogeneity of these pathologies, several groups have benefited of increased knowledge such as sarcomas and lymphomas. The need of international collaboration to study prospectively some subgroups of tumours is crucial.

SUMMARY

Rare bladder cancers have generally poor outcome and in a majority of the cases surgery, namely cystectomy remains the most important curative treatment. Specific subgroups, as lymphoma, sarcoma and dedifferentiated epithelial tumours may benefit of molecular characterization and trials with targeted drugs.