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Tanguturi Yella V, Tanguturi Yella SS, Kota KS, Tanguturi Yella SH, Thangaraju P. A Very Rare Disease of Patent Urachus Cyst With Vesico-Umbilical Urinary Fistula in Adults: A Case Report and Short Review. Cureus 2023; 15:e41503. [PMID: 37551248 PMCID: PMC10404365 DOI: 10.7759/cureus.41503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Rare developmental anomalies known as urachal remnants are brought on by flaws in the foetal developmental process. However, depending on the location and degree of incomplete obliteration, the urachus can undergo a variety of urachal anomalies. An umbilical fistulogram and a voiding cystourethrogram both supported the existence of the adult urachal cyst in this case. To treat the sepsis, we provided the patient with antibiotics first, then a surgical procedure. The entire vesico-umbilical tract with the urachal cyst was removed using the open approach. The excised specimen's histology revealed a foreign body giant cell reaction without any indication of malignancy. The presentation and diagnosis of vesico-umbilical urinary fistula (VUUF) in adults can occasionally be difficult. They happen very rarely. So we began putting forward this case for the same reason.
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Affiliation(s)
| | | | - Krishna Sasanka Kota
- Ear, Nose and Throat (ENT) and Head and Neck Surgery (HNS), All India Institute of Medical Sciences (AIIMS) Deoghar, Deoghar, IND
| | | | - Pugazhenthan Thangaraju
- Pharmacology and Therapeutics, All India Institute of Medical Sciences (AIIMS) Raipur, Raipur, IND
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2
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Abstract
Urachus is an embryonic organ related to the bladder that degenerates after birth. Defective obliteration of the urachus leads to urachal malformations, the most common of which is a urachal cyst. A urachal cyst is often misdiagnosed due to its myriad presentations. Delay in diagnosis can lead to complications such as sepsis, fistula formation, and rupture of the cyst mimicking peritonitis. Hence, a high index of suspicion is required for the timely diagnosis and management of urachal cysts presenting in the emergency room. We report the case of a 32-year-old woman who presented with clinical features suggestive of an acute abdomen. The judicious use of imaging confirmed the diagnosis of an infected urachal cyst, which was surgically managed.
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Affiliation(s)
- Sruthi Jayakumar
- Epidemiology and Public Health, Chest Research Foundation, Respiratory Research Network, Pune, IND
| | - Danny Darlington
- Urology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
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3
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Qin LF, Liang Y, Xing XM, Wu H, Yang XC, Niu HT. Villous adenoma coexistent with focal well-differentiated adenocarcinoma of female urethral orifice: A case report and review of literature. World J Clin Cases 2019; 7:891-897. [PMID: 31024961 PMCID: PMC6473125 DOI: 10.12998/wjcc.v7.i7.891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/10/2019] [Accepted: 01/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Villous adenomas of the urinary tract are uncommon. They are morphologically similar to and difficult to differentiate from their counterpart in the colon. The histogenesis and malignant potential are uncertain.
CASE SUMMARY A 63-year-old woman was admitted to our hospital with a mass in the urethral orifice. Gross and microscopic pathological examination was suggestive of urethral villous adenoma with focal well-differentiated adenocarcinoma. The whole urethra and part of the bladder were excised. No further treatment was offered. Carcinoembryonic antigen, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, and p53 protein were positive, and the ratio of Ki-67 was 60%. After follow-up at 11 mo, the patient was cured and had no recurrence.
CONCLUSION Immunohistochemistry is important for differential diagnosis of villous adenoma of the urinary system. Complete surgical resection of the urinary tract is curative.
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Affiliation(s)
- Lu-Feng Qin
- Department of Medicine, Qingdao University, Qingdao 266003, Shandong Province, China
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Ye Liang
- Key Laboratory of Urinary System Diseases, Qingdao 266003, Shandong Province, China
| | - Xiao-Ming Xing
- Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hui Wu
- Department of Medicine, Qingdao University, Qingdao 266003, Shandong Province, China
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xue-Cheng Yang
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hai-Tao Niu
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
- Key Laboratory of Urinary System Diseases, Qingdao 266003, Shandong Province, China
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Ugwuoke O, Hadjipavlou M, Pinto T, Arora A, Hammadeh MY. Villous adenoma of the urachal remnant: A diagnostic conundrum. Rare Tumors 2018; 10:2036361318779514. [PMID: 29899888 PMCID: PMC5990874 DOI: 10.1177/2036361318779514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/02/2018] [Indexed: 11/15/2022] Open
Abstract
Villous adenoma is a rare pathology seen in the urinary tract; it is mostly found in the large bowel. When encountered in the urinary tract, it mainly originates from intestinal segments of urinary reconstruction. Villous adenoma is commonly seen in patients more than 50 years and has a male predominance. In the urinary tract, it has been reported in the urachus, bladder dome and trigone. A few cases of villous adenoma have been described in the literature. We report a case of primary villous adenoma in the remnant of the urachus and discuss the pathophysiology, investigation and management.
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Affiliation(s)
- Obianuju Ugwuoke
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - Marios Hadjipavlou
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK.,Urology Centre, Guy's Hospital, London, UK
| | - Thelma Pinto
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
| | - Ajay Arora
- Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Kent, UK
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Khan R, Ibrahim H, Tulpule S, Iroka N. Bladder cancer in a young patient: Undiscovered risk factors. Oncol Lett 2016; 11:3202-3204. [PMID: 27123090 DOI: 10.3892/ol.2016.4355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 02/04/2016] [Indexed: 11/05/2022] Open
Abstract
Bladder cancer is one of the most common forms of malignancies involving the urinary system and multiple risk factors have been associated with its etiology. The most common of which include cigarette smoking and various occupational or chemical exposures. It is usually diagnosed in older individuals with an average age of 70. In rare cases it is observed in children as well as young adults where it usually presents as a low-grade, non-invasive disease. In the present case report a 27-year-old male patient is discussed: The patient presented with no significant risk factors and was treated for mucinous adenocarcinoma of the bladder while further investigations were performed to identify other associated factors related to this form of malignancy. Debate in the literature exists in regards to the characteristics of bladder neoplasms in younger patients compared with older patients, however there is a lack of research into the etiology or prognosis in young patients. The present case study illustrates the case of a young adult with no clear risk factors who was diagnosed with a rare case of mucinous adenocarcinoma of the bladder.
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Affiliation(s)
- Rafay Khan
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Hiyam Ibrahim
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Sunil Tulpule
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Nneka Iroka
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
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6
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Updates in the Pathologic Diagnosis and Classification of Epithelial Neoplasms of Urachal Origin. Adv Anat Pathol 2016; 23:71-83. [PMID: 26849813 DOI: 10.1097/pap.0000000000000110] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since the publication of the World Health Organization "blue book" in 2004, several recent studies have provided new insights on the pathologic aspects of urachal neoplasms. The proposed updates include modified criteria for the diagnosis of urachal carcinoma. A uniform nomenclature for cystic tumors was lacking, and it is recommended that urachal mucinous cystic tumors should be separated and classified in a manner similar to ovarian mucinous neoplasms. The spectrum includes mucinous cystadenoma, mucinous cystic tumor of low malignant potential, mucinous cystic tumor of low malignant potential with intraepithelial carcinoma, and microscopically or frankly invasive mucinous cystadenocarcinoma, with 65% of cystic tumors classified as mucinous cystic tumor of low malignant potential. Most importantly, it has been shown that progression-free survival of noninvasive mucinous cystic tumors is significantly better than noncystic invasive adenocarcinoma. This development, along with prior descriptions of urachal villous adenoma, has also reaffirmed the occurrence of benign tumors of urachal epithelial origin. For noncystic (usual) invasive adenocarcinomas, the traditionally described histologic subtypes of enteric, mucinous, signet ring cell, not otherwise specified, and mixed remain appropriate, with 50% of tumors classified as mucinous subtype. Although this subtyping is helpful in diagnosis and differential diagnosis, the clinical significance of subtyping adenocarcinoma is still uncertain. Rare nonglandular morphologies such as urothelial, squamous, and neuroendocrine carcinoma in urachal carcinomas have been described in detail with proposals for their own set of diagnostic criteria. These criteria are based on unique features of urachal nonglandular carcinomas. Among the immunomarkers studied, only β-catenin and CK7 may be of help in the distinction of urachal from colorectal adenocarcinoma. Awareness of the expression profile of immunomarkers such as CDX2, P504S (racemase), PSMA, claudin-18, and REG IV in urachal tumors and in tumors in the differential diagnosis is important to avoid overreliance of these markers in the diagnosis. Limited studies have identified KRAS mutations interestingly only in mucinous adenocarcinoma and exclusive of MSI loss, and mutations in BRAF are not present. Several alternative tumor staging approaches (eg, Mayo, Ontario, TNM systems) different from the traditional staging proposed by Sheldon are used that provide better tumor distribution across stages; however, the prognostic utility of the stage substratification has yet to be validated in large prospective studies. Evidence though suggests that staging urachal cancer is most pertinent when dichotomized to tumors that have spread outside versus within the perivesical tissue. Only high tumor stage and residual tumor after surgery have been shown to be independent predictors of outcome. This review updates the contemporary classification of urachal epithelial tumors, which has informed the upcoming 2016 classification of World Health Organization tumors. We provide modified criteria for diagnosing urachal adenocarcinomas, which remains a clinico-pathologic exercise. The role of ancillary diagnostic methodology and issues pertaining to staging and prognostication are presented.
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Sagnotta A, Dente M, Socciarelli F, Cacchi C, Stoppacciaro A, Balducci G. Primary adenocarcinoma of the renal pelvis: histologic features of a stepwise process from intestinal hyperplasia to dysplasia in a patient with chronic renal abscess. Int J Surg Pathol 2013; 22:182-5. [PMID: 24008439 DOI: 10.1177/1066896913502225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pure adenocarcinomas of the urothelium are very rare and their location in the pelvis is uncommon. Although their pathogenesis is not well defined, adenocarcinomas are likely to originate from neoplastic transformation of the glandular cells of the urothelial intestinal metaplasia usually arising in response to chronic irritating stimuli, such as long-duration inflammation, urolithiasis, and hydronephrosis. We report a case of an 81-year-old woman who underwent right nephrectomy for relapsing renal abscess due to a staghorn calculus. Histological examination disclosed an infiltrating adenocarcinoma arising from a tubulovillous adenoma with the surrounding pelvic mucosa showing a sequence of intestinal metaplasia, low- and high-grade villous adenoma, and invasive adenocarcinoma, supporting the hypothesis of cancer progression due to chronic inflammation from the urothelium through the metaplasia step.
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Affiliation(s)
- Andrea Sagnotta
- 1Department of General Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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8
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Kao CS, Epstein JI. Tubular adenoma of the urinary tract: a newly described entity. Hum Pathol 2013; 44:1890-4. [DOI: 10.1016/j.humpath.2013.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 01/13/2023]
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Hudson J, Arnason T, Merrimen JL, Lawen J. Intestinal type villous adenoma of the renal pelvis. Can Urol Assoc J 2013; 7:E138-42. [PMID: 23671505 PMCID: PMC3650791 DOI: 10.5489/cuaj.257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Intestinal type villous adenomas are uncommon in the genitourinary tract. Most reported cases have been located in the urinary bladder or urachus. Villous adenoma arising in the renal pelvis or ureter is very rare. We present a case of an 81-year-old female who presented with difficulty voiding and mucosuria. A computed tomography scan identified right-sided hydronephrosis, renal parenchymal atrophy, nonobstructing calculi and a lower pole renal mass. She underwent open right nephrectomy. Histopathologic examination of the kidney revealed an intestinal type villous adenoma of the renal pelvis with high-grade dysplasia and focal areas suspicious for invasive adenocarcinoma. We review the four previously reported cases of intestinal type villous adenoma in the renal pelvis and discuss diagnosis and management of this unusual neoplasm.
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Affiliation(s)
- Jill Hudson
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Thomas Arnason
- Division of Anatomical Pathology, Department of Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Jennifer L.O. Merrimen
- Division of Anatomical Pathology, Department of Laboratory Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Joseph Lawen
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
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10
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Pan D, Tay YK, Donnellan S. Synchronous urothelial carcinoma of the bladder and urachal adenoma with subsequent malignant transformation. Korean J Urol 2012; 53:438-40. [PMID: 22741056 PMCID: PMC3382697 DOI: 10.4111/kju.2012.53.6.438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 11/07/2011] [Indexed: 11/21/2022] Open
Abstract
Malignant transformation of urachal adenoma is exceedingly rare, with intestinal metaplasia as the most common contributing mechanism. It is recommended that a urachal adenoma be regarded as a pre-malignant condition and be subject to endoscopic surveillance. A local en block excision of the tumor mass with urachalectomy and umbilectomy results in possible long-term survival. The median survival after platinum-based chemotherapy is limited for patients with extravesical disease. Here we report a case of synchronous urothelial carcinoma of the bladder and urachal adenoma that transformed into adenocarcinoma.
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Affiliation(s)
- David Pan
- Department of Urology, Monash Medical Centre, Southern Health, Victoria, Australia
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11
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Chan LP, Liu CM, Ke TY. Villous Adenoma Found in Voided Urine Cytology. UROLOGICAL SCIENCE 2010. [DOI: 10.1016/s1879-5226(10)60043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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von Schnakenburg L, Cadosch D, Gautschi O. Infizierte Urachuszyste im Erwachsenenalter. Urologe A 2010; 49:1176-8. [DOI: 10.1007/s00120-010-2322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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A Giant Mucinous Adenocarcinoma Arising within a Villous Adenoma of the Urachus: Case Report and Review of the Literature. Case Rep Med 2010; 2009:818646. [PMID: 20182635 PMCID: PMC2825668 DOI: 10.1155/2009/818646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 12/14/2009] [Indexed: 12/16/2022] Open
Abstract
We present an exceptional case of a giant urachal tumor, consisting of both villous adenoma and mucinous adenocarcinoma of the urachus. The tumor was incidentally discovered during investigations for renal failure. Initial transurethral biopsies showed only a villous adenoma of the urachus. Although the biopsies showed no malignancy, a radical cystoprostatectomy and broad excision of the urachus and umbilicus were performed. At the same time, a bilateral nephroureterectomy was performed because of reflux-nephropathy and renal failure. The indication for surgery was based on the typical imaging aspects, raising the suspicion of an underlying urachal adenocarcinoma (size and location). Indeed, at final histopathology a concomitant well-differentiated adenocarcinoma of the urachus confined to the urachal mucosa was found. The patient remained free of disease for 50 months of follow-up. Only three previous cases of urachal adenocarcinoma associated with villous adenoma have been described.
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Sigalas K, Tyritzis SI, Trigka E, Katafigiotis I, Kavantzas N, Stravodimos KG. A male presenting with a primary mucinous bladder carcinoma: a case report. CASES JOURNAL 2010; 3:49. [PMID: 20205820 PMCID: PMC2824640 DOI: 10.1186/1757-1626-3-49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 02/03/2010] [Indexed: 11/10/2022]
Abstract
Background The primary mucinous adenocarcinoma of the bladder is an extremely rare urologic entity, which is found in less than 2% of all urinary bladder tumours and is often presented as metastatic. Case presentation A 69-year old male patient was diagnosed with a primary mucinous adenocarcinoma of the bladder after undergoing a transurethral resection of a bladder tumour and complete examination of the entire gastrointestinal tract to rule out other primary cites. Immunohistochemistry confirmed the nature of the tumour. The patient underwent a radical cystoprostatectomy with en block bilateral pelvic lymphadenectomy and urinary diversion with a Bricker ileostomy. Conclusion The primary adenocarcinoma creates a diagnostic dilemma, since it cannot be easily differentiated by the adenocarcinoma that originates from the colon and the prostate. We advocate the radical surgical management, after exclusion of any primary malignant sites related to the gastrointestinal tract. The immunohistochemistry has a leading role, assisting with the differential diagnosis.
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Affiliation(s)
- Konstantinos Sigalas
- Department of Urology, Athens University Medical School-LAIKO Hospital, Athens, Greece.
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Infected urachal cyst in an adult: a case report and review of the literature. CASES JOURNAL 2009; 2:6422. [PMID: 19829803 PMCID: PMC2740315 DOI: 10.4076/1757-1626-2-6422] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 05/25/2009] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. They are very rarely seen in adults because the urachus is normally obliterated in early infancy. CASE PRESENTATION We describe a case of a 32 year old male Caucasian who presented with a tender, midline, infraumbilical mass and purulent umbilical discharge. Diagnosis of an infected urachal cyst was confirmed on magnetic resonance scan. He was treated initially with broad spectrum antibiotics in order to allow sepsis to resolve prior to surgical excision of the cyst and fibrous tract. Cystoscopy was performed intraoperatively to exclude sinus communication with the bladder. Histology of the excised specimen showed chronic inflammation with no evidence of malignancy. Postoperative recovery was uneventful. CONCLUSION Urachal abnormalities are rare in adults. Clinical presentation is non-specific; therefore, a high index of suspicion is required in order to make the diagnosis. When diagnosed, surgical excision is advised because of the risk of malignant transformation.
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Recurrent villous adenoma with high-grade dysplasia arising in a urethral diverticulum. Case Rep Med 2009; 2009:361212. [PMID: 19718251 PMCID: PMC2729294 DOI: 10.1155/2009/361212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 04/01/2009] [Indexed: 01/26/2023] Open
Abstract
Villous adenomas of the urinary tract are an uncommon, well-recognized entity, described in different locations. However, the occurrence of this lesion in the female urethral diverticulum is very unusual. We present the first case of a recurrent villous adenoma with high-grade dysplasia unassociated with adenocarcinoma, arising from a urethral diverticulum. A 75-year-old African-American female presented with urethral prolapse complaining of mild voiding difficulty, stress incontinence, and mild spotting of blood. Histological examination revealed a papillary lesion with finger-like processes lined by pseudostratified columnar epithelium with abundant goblet cells. There were focal areas with stratification to the luminal surface and loss of nuclear polarity and atypical mitoses, interpreted as villous adenoma with high-grade dysplasia. The lesion
recurred at one year without evidence of malignant transformation. We also present a brief literature review of urothelial villous adenomas.
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Macher-Goeppinger S, Aulmann S, Haferkamp A, Hohenfellner M, Schirmacher P, Bläker H. Villöses Urachusdivertikeladenom mit Langzeitmukusurie. DER PATHOLOGE 2008; 29:305-7. [DOI: 10.1007/s00292-008-0993-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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