Malignant transformation of a urachal cyst-a case report and literature review

A rare case of urachal adenocarcinoma with bone marrow metastasis

Urachal cancer is a rare and aggressive cancer that often presents in advanced stages. Given the rarity of this malignancy, medical case studies provide one of the few sources of literature available through which clinicians can guide medical management. Surgery is widely considered to be the mainstay of therapy when disease is localised and surgically resectable, therefore most current case studies on urachal cancer focus on surgical management, occasionally with adjuvant chemotherapy. However, few case studies discuss chemotherapy alone in the treatment of metastatic disease. Most studies indicate a median overall survival between 12 and 24 months for metastatic urachal adenocarcinoma. Bone marrow metastasis of solid tumours, when considered alone, portends a poor prognosis. The patient in this case study represents a rare case of stage IV urachal adenocarcinoma metastatic to the bone marrow without progression of disease after 6 months of treatment.

Surgical strategy of urachal remnants in children

A urachus is a vestigial tubular structure that connects the urinary bladder to the allantois during early embryonic development. Urachal remnants are classified as patent urachus, urachal sinus, urachal cyst, and urachal diverticulum. Ten patients with urachal remnants underwent surgery at our institution between 2015 and 2019. Six patients had a urachal sinus, and four had a urachal diverticulum. Two patients with urachal sinus underwent excision of the urachal remnant, from the umbilicus to the urinary bladder, using an umbilical approach. The other four patients with urachal sinus underwent laparoscopic surgery with excision of the urachal remnant, from the umbilicus to the urinary bladder. All patients with urachal diverticulum underwent open excision of the diverticulum through a Pfannenstiel incision. Pathologic examination of all urachal remnants showed no evidence of neoplasm and complete excision. All patients had an uneventful postoperative course and are doing well.