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Bermúdez Barrientos CG, Ramos Portales M, Mendoza Villalobos ET, Moreno Jaime B. Acute Glomerulonephritis as a Paraneoplastic Syndrome Secondary to Urachal Adenocarcinoma: An Unknown Entity. Cureus 2024; 16:e60106. [PMID: 38860075 PMCID: PMC11164558 DOI: 10.7759/cureus.60106] [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: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
Urachal carcinoma is an uncommon malignancy with a peculiar biomolecular characterization and therefore a complex approach. It was incorporated by the World Health Organization in 2004 in the tumors of the urinary system classification. This neoplasm is generally diagnosed in advanced stages. The standard treatment is surgical, however, due to the rarity and relatively late clinical manifestation of urachal carcinomas, the survival data are mostly case reports, as well as information about medical-surgical treatment based on evidence. The data used were extracted from both the physical and electronic clinical records. Among atypical presentations reported in the literature, we report a case of urachal adenocarcinoma with simultaneous glomerulonephritis as a paraneoplastic syndrome of which there is no report to date. Surgery was carried out in our patient, unfortunately with lifetime morbidity from kidney function replacement secondary to kidney function damage by glomerulonephritis, despite previous immunosuppression treatment for rapidly progressive glomerulonephritis. It is worth mentioning that if the initial diagnosis represents a clinical challenge, treatment is even more complex, given the little information that currently exists about it. Urachal carcinoma is a diagnostic and treatment challenge. Up to now, surgery has been the treatment of choice in localized or locally advanced disease, however, with a high morbidity for the patient.
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Affiliation(s)
| | - Marisol Ramos Portales
- General Surgery, Institute for Social Security and Services for State Workers Regional Hospital, Leon, MEX
| | - Edna T Mendoza Villalobos
- Nephrology, Institute for Social Security and Services for State Workers Regional Hospital "Dr. Valentín Gómez Farías", Guadalajara, MEX
| | - Brizio Moreno Jaime
- Medical Oncology, Institute for Social Security and Services for State Workers Regional Hospital, Leon, MEX
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Grant CR, Benjamin DJ, Cramer S, Rezazadeh Kalebasty A. A remnant never forgotten: the utility of circulating tumor DNA in treatment guidance of urachal cancer. Ther Adv Med Oncol 2024; 16:17588359241230743. [PMID: 38425988 PMCID: PMC10903217 DOI: 10.1177/17588359241230743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
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.
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Affiliation(s)
- Christopher Ryan Grant
- Department of Medicine, University of California Irvine Medical Center, UC Irvine Health, 200 S Manchester Avenue, Room 423, Orange, CA 92868, USA
| | | | - Scott Cramer
- Department of Radiology, University of California Irvine Medical Center, Orange, CA, USA
| | - Arash Rezazadeh Kalebasty
- Division of Hematology/Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
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Kochvar AP, Bednar G, Albani JM. Low-Grade Urachal Cystadenoma With Abundant Calcification Removed Using Robot-Assisted Laparoscopy: A Case Report. Cureus 2023; 15:e47209. [PMID: 38021666 PMCID: PMC10653121 DOI: 10.7759/cureus.47209] [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: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Andrew P Kochvar
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Grant Bednar
- College of Osteopathic Medicine, Kansas City University, Kansas City, USA
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Van Breusegem P, Verswijvel G, Fransis S, Van der Speeten K. Peritoneal Surface Malignancies Originating From Urachal Carcinoma: Case Reports and Review of the Literature. Indian J Surg Oncol 2023; 14:109-121. [PMID: 37359934 PMCID: PMC10284781 DOI: 10.1007/s13193-022-01679-4] [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: 07/09/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022] Open
Abstract
Urachal carcinoma (UC) is a rare and aggressive tumor arising from the urachal remnants, with the potential for peritoneal dissemination. Patients diagnosed with UC often have a poor prognosis. To date, there is no standardized treatment. Our objective is to present two cases of patients with peritoneal carcinomatosis (PC) secondary to an UC, who were treated with cytoreductive surgery (CRS) and hyperthermic peroperative intraperitoneal chemotherapy (HIPEC). A review of the literature on CRS and HIPEC in UC suggests CRS and HIPEC to be a safe and viable treatment option. Two patients with PC of UC underwent CRS and HIPEC in our institution. All available data were gathered and reported on. A literary search was carried out to find all available cases of patients with PC secondary to UC treated with CRS and HIPEC. Both patients underwent CRS and HIPEC and are currently free of recurrence. Literature research revealed nine other publications adding up to a total of 68 additional cases. CRS and HIPEC can provide satisfactory long-term oncological outcome with acceptable morbidity and mortality rates in patients with PC of urachal origin. It should be considered as a safe and feasible treatment option with curative potential.
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Affiliation(s)
- Paulien Van Breusegem
- Department of Surgical Oncology, Hospital Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | | | - Sabine Fransis
- Department of Pathology, Hospital Oost-Limburg, Genk, Belgium
| | - Kurt Van der Speeten
- Department of Surgical Oncology, Hospital Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, University Hasselt, Hasselt, Belgium
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Ke C, Hu Z, Yang C. Preoperative accuracy of diagnostic evaluation of urachal carcinoma. Cancer Med 2023; 12:9106-9115. [PMID: 36734315 PMCID: PMC10166928 DOI: 10.1002/cam4.5648] [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: 11/01/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We analyzed the clinical data of patients with urachal carcinoma (UrC) in order to strengthen urologists' understanding of UrC and improve preoperative diagnosis. METHODS The clinical data of 37 patients with UrC admitted to our hospital from October 2005 to April 2022 were retrospectively analyzed, and 40 patients with urothelial carcinoma (UCa) of bladder were enrolled as the control group. We compared and analyzed the imaging, cystoscopy and immunohistochemistry, serum tumor markers, fluorescence in situ hybridization (FISH) of UrC and bladder UCa for early diagnosis and evaluation of diagnostic accuracy. RESULTS A total of 37 patients with UrC were enrolled in this study, including 30 males and seven females, with a median age of 52.00 (44.50-63.50) years. Imaging and cystoscopy suggest that UrC grows primarily outside the bladder cavity and is found in the middle line of the dome or anterior wall of the bladder. There was a significant difference in tumor location between the UrC group and the UCa group (10.13 mm vs. -7.06 mm, p < 0.001). Immunohistochemistry revealed that CK20 and CDX-2 were both diffusely and strongly positive. β-catenin was strongly positive in cytoplasm and membrane, but negative in nuclear staining. Carcinoembryonic antigen (CEA) and carbohydrate antigen 72-4 (CA724) expression levels were significantly higher in the UrC group than in the UCa group (p < 0.05). In the diagnosis of UrC, the area under the curve (AUC) of CEA combined with CA724 was the greatest. FISH's sensitivity in diagnosing UrC (5/7, 71.43%) was not significantly different from that of UCa (71.43% vs. 77.50%, p = 0.659). Imaging examination has the highest sensitivity and specificity among the accuracy evaluation of different diagnostic methods. CONCLUSIONS Imaging and cystoscopy are the powerful diagnostic methods for UrC. Serum tumor markers may assist in diagnosis, prognosis, and monitoring. Positive urine FISH can easily misdiagnose UrC as UCa.
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Affiliation(s)
- Chunjin Ke
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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Tiutiucă RC, Năstase Pușcașu AI, Țarcă E, Stoenescu N, Cojocaru E, Trandafir LM, Țarcă V, Scripcariu DV, Moscalu M. Urachal Carcinoma, An Unusual Possibility of Hematuria; Case Report and Literature Review. Diagnostics (Basel) 2022; 12:1892. [PMID: 36010242 PMCID: PMC9406625 DOI: 10.3390/diagnostics12081892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Urachal cancer is very rare, accounting for only 0.5-2% of bladder-associated malignancies and 0.01% of all cancers in adults. It has an insidious appearance, an aggressive behavior and a poor prognosis. The most common symptoms are hematuria and the presence of a palpable hypogastric mass. The scarcity of cases and the low number of studies carried out explains the lack of an evidence-based management strategy, but it seems that surgical treatment (open, laparoscopy or robot-assisted) represents the gold standard, while neoadjuvant and adjuvant chemotherapy or radiotherapy has a limited impact on overall survival. Since mucinous cystadenocarcinoma of urachal origin is a very uncommon pathological condition the differential diagnosis may be difficult and pathological investigations have to elucidate this disorder. It is worth mentioning the psychological impact on the patient in addition to the medical aspects. A rare condition is associated with heightened risk for mental health and psychosocial difficulties and this must be taken into account in the subsequent follow-up of the patient. In order to increase awareness of this rare entity we report a case of a 40-year-old male with a urachal adenocarcinoma who was treated surgically, with a favorable outcome. We also perform a brief literature review about this type of tumor.
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Affiliation(s)
- Răzvan Călin Tiutiucă
- Surgical Department, Iacob Czihac Military Emergency Clinical Hospital, 700483 Iasi, Romania
| | | | - Elena Țarcă
- Department of Surgery II-Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Nicoleta Stoenescu
- Surgical Department, Iacob Czihac Military Emergency Clinical Hospital, 700483 Iasi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Mihaela Trandafir
- Department of Mother and Child, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Viorel Țarcă
- Department of Communication Sciences, Apollonia University, 700613 Iasi, Romania
| | - Dragoș-Viorel Scripcariu
- Surgical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Loizzo D, Pandolfo SD, Crocerossa F, Guruli G, Ferro M, Paul AK, Imbimbo C, Lucarelli G, Ditonno P, Autorino R. Current Management of Urachal Carcinoma: An Evidence-based Guide for Clinical Practice. EUR UROL SUPPL 2022; 39:1-6. [PMID: 35309098 PMCID: PMC8927909 DOI: 10.1016/j.euros.2022.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
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.
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