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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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Yan J, Li H, Yan G, Duan Q, Tang C, McClure MA, Bhetuwal A, Li Y, Yang L, Li R, Tan G, Feng B. Primary urachal leiomyosarcoma: a case report and literature review of clinical, pathological, and medical imaging features. Front Oncol 2023; 13:1228178. [PMID: 37664058 PMCID: PMC10470618 DOI: 10.3389/fonc.2023.1228178] [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: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Urachal tumors are exceedingly rare, and adenocarcinoma is the most common malignant urachal neoplasm. Here, an especially rare patient of primary urachal leiomyosarcoma from our hospital was reported, and only five patients have been reported thus far since 1981. Case description A 24-year-old man was admitted due to urinary tract symptoms. Both urogenital ultrasonography and contrast-enhanced computed tomography showed a mass at the dome of the urinary bladder. Laparoscopic surgical resection was performed, and histopathologic examination of the mass confirmed the diagnosis of urachal leiomyosarcoma. No recurrence was noted after one and a half years. Conclusions Because the leiomyosarcoma located in the extraperitoneal space of Retzius and may manifest with nonspecific abdominal or urinary symptoms, early and definitive preoperative diagnosis is challenging. Partial cystectomy with complete excision of the urachus is recommended. Because only a few patients have been recorded, clinical outcomes and recurrence risks are difficult to assess.
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Affiliation(s)
- Jing Yan
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Hongwei Li
- Department of Radiology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Gaowu Yan
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Qing Duan
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Chunyan Tang
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Morgan A. McClure
- Department of Radiology and Imaging, Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yong Li
- Department of Radiology, Suining Central Hospital, Suining, China
| | - Ling Yang
- Department of Pathology, Suining Central Hospital, Suining, China
| | - Ruyi Li
- Department of Radiology, Lixian People’s Hospital, Aba, China
| | - Gangcheng Tan
- Department of Radiology, Lixian People’s Hospital, Aba, China
| | - Bo Feng
- Department of Radiology, Lixian People’s Hospital, Aba, China
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Patel J, Villegas A. Urachal Adenocarcinoma: A Rare Primary Cancer Managed With FOLFOX Chemotherapy. Cureus 2023; 15:e43849. [PMID: 37736429 PMCID: PMC10510567 DOI: 10.7759/cureus.43849] [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: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
Urachal adenocarcinoma (UA) represents a rare subset of bladder tumors involving a urachal remnant. Incidental gross hematuria is often the only presenting symptom, with patients often presenting late in their course, thereby imparting an overall poor prognosis. Although there are prior case reports, there is little literature reported and no standardized treatment guidelines. We report a case of a middle-aged male who presented with incidental gross hematuria after a fall. Workup indicated the presence of a calcified bladder dome mass and pathology reported a primary urachal adenocarcinoma with pelvic nodal involvement. Patient underwent surgical resection and subsequent adjuvant, systemic chemotherapy regimen with leucovorin, fluorouracil, and oxaliplatin (FOLFOX). We hope to bring greater awareness to this rare cause of bladder malignancy.
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Affiliation(s)
- Jay Patel
- Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - Augusto Villegas
- Hematology and Oncology, Florida Cancer Specialists, Fleming Island, 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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Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Coquan E, Laramas M, Thibault C, Abbar B, Mesnard B, Borchiellini D, Dumont C, Boughalem E, Deville JL, Cancel M, Saldana C, Khalil A, Baciarello G, Flechon A, Walz J, Gravis G. Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group. Front Oncol 2023; 13:1110003. [PMID: 36741023 PMCID: PMC9892758 DOI: 10.3389/fonc.2023.1110003] [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] [Received: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.
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Affiliation(s)
- M. Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France,*Correspondence: M. Guerin,
| | - C. Miran
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - E. Colomba
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - M. Cabart
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - T. Herrmann
- Department of Medical Oncology, Centre Jean-Perrin, Clermont-Ferrand, France
| | - S. Pericart
- Department of Anatomo-pathology, Institut Universitaire du Cancer, Centre Hospital-Universitaire de Toulouse, Toulouse, France
| | - D. Maillet
- Department of Medical Oncology, Centre hospitalo-Universitaire Hospices civils, Lyon, France
| | - Y. Neuzillet
- Department of Urology, Hopital Foch, Paris, France
| | - A. Deleuze
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - E. Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M. Laramas
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Grenoble, France
| | - C. Thibault
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | - B. Abbar
- Department of Medical Oncology, Hopital Pitié-Salpetriere, Paris, France
| | - B. Mesnard
- Department of Urology, Centre Hospitalo-Universitaire, Nantes, France
| | - D. Borchiellini
- Department of Medical Oncology, Centre Lacassagne, Nice, France
| | - C. Dumont
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | - E. Boughalem
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - JL. Deville
- Department of Medical Oncology, Centre Hospitalo-Universitaire Timone, Marseille, France
| | - M. Cancel
- Department of Medical Oncology, Centre Hospitalo-Universitaire Bretonneau, Tours, France
| | - C. Saldana
- Department of Medical Oncology, Hopital Henri Mondor, Paris, France
| | - A. Khalil
- Department of Medical Oncology, Hopital tenon, Paris, France
| | - G. Baciarello
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - A. Flechon
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - J. Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - G. Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
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Urachal Carcinoma, An Unusual Possibility of Hematuria; Case Report and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12081892. [PMID: 36010242 PMCID: PMC9406625 DOI: 10.3390/diagnostics12081892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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