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Tilahun SB, Tolessa SM, Shiferaw SF, Wake AG. Primary urachal adenocarcinoma: Case report. Int J Surg Case Rep 2024; 120:109791. [PMID: 38810293 PMCID: PMC11153893 DOI: 10.1016/j.ijscr.2024.109791] [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: 04/05/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary urachal adenocarcinoma (PUA) is a rare form of cancer that arises from the urachus, a vestigial remnant of the allantois and cloaca during embryonic development. The exact pathogenesis of PUA is not well understood, but it is believed to arise from glandular epithelium remnants within the urachus. The rarity of this type of cancer makes it difficult to comprehensively study its epidemiology. CASE PRESENTATION This case report describes a 47-year-old male patient who presented with intermittent painless hematuria and fatigue for two months. Cystoscopy showed a single growth at the dome of the urinary bladder, and abdominopelvic CT scan with contrast revealed a 3*2 cm enhancing growth at the dome of the bladder suspicious of urachal origin tumor. The patient was diagnosed with urachal adenocarcinoma (PT2) after pathological examination. The patient underwent partial cystectomy and umbilicectomy. CLINICAL DISCUSSION Patients with PUA often present with nonspecific symptoms that can delay the diagnosis. The most common symptom is hematuria, which is present in approximately two-thirds of the patients. The diagnosis of PUA is challenging and relies on a combination of clinical presentation, imaging, and histopathological examination. CONCLUSION The mainstay of treatment for PUA is surgical resection, which may include partial cystectomy or radical cystectomy with en bloc resection of the urachus and umbilicus. It is esential to report all cases of primary urachal adenocrcinoma.
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Affiliation(s)
- Seyfe Bekele Tilahun
- Addis Ababa University, College of Health Sciences, Department of Surgery, Addis Ababa, Ethiopia.
| | - Sewunet Muluneh Tolessa
- Addis Ababa University, College of Health Sciences, Department of Surgery, Addis Ababa, Ethiopia
| | - Samuel Fekadu Shiferaw
- Addis Ababa University, College of Health Sciences, Department of Surgery, Addis Ababa, Ethiopia
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Ryan PC, Kelly C, Afridi I, Fawaz A, Aboelmagd M, Cullen IM, Keane JP, Daly PJ. Surgical treatment of urachal remnants in an adult population-a single-centre experience. Ir J Med Sci 2023; 192:3023-3027. [PMID: 36935447 PMCID: PMC10692245 DOI: 10.1007/s11845-023-03339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Urachal remnants are a rare congenital defect resulting from failure of obliteration of a fibrous tube that connects the umbilicus to the bladder dome during embryological development. Oftentimes a urachal remnant will go undiagnosed, but occasionally a patient may present with a variety of symptoms, ultimately leading to the identification of the remnant. Given its rarity, there is very limited literature available on the management of symptomatic urachal remnants, especially in adults. Surgical resection has been the first-line management of urachal remnants for years, especially given the risk of the development of urachal adenocarcinoma secondary to recurrent infection, persistent irritation, and urinary stasis associated with some urachal remnants. AIM We present our experience in the management of symptomatic urachal remnants in adults at our institute and perform a brief literature review of the same. METHODS A retrospective review of all cases who underwent surgical management of symptomatic urachal remnants between December 2015 and January 2022 was performed. Seven cases of urachal remnant excision in total were identified over the time period. Patient characteristics and perioperative parameters were analysed. Post-operative complications were measured in accordance with the Clavien-Dindo grading system. RESULT In total, 7 cases of urachal remnants were treated at our institute over the study period. Four patients were treated with a TURBT and 3 patients were treated with a laparoscopic partial cystectomy. There were no intraoperative complications and one post-operative complication requiring readmission for intravenous antibiotics. There was one mortality but this was not as a direct result of the operative procedure. Mean length of stay was 1.71 days. Two of patients had histologically confirmed urachal adenocarcinoma and the remaining five patients had benign histology. Each patient was seen in the outpatients department 6 weeks post-operatively for clinical review and review of histology. No further follow-up was required for the patients with benign histology given resolution of symptoms and follow-up for the malignant histology was arranged appropriately following MDM. CONCLUSION There is a paucity of data available on the management of urachal remnants in the adult population; however, an endoscopic or laparoscopic approach is a safe and effective method of excising symptomatic urachal remnants.
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Affiliation(s)
- Paul C Ryan
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland.
| | - Caroline Kelly
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
| | - Irfan Afridi
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
| | - Aisling Fawaz
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
| | - Mohammed Aboelmagd
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
| | - Ivor M Cullen
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
| | - John P Keane
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
| | - Padraig J Daly
- Department of Urology, University Hospital Waterford, Dunmore Road, Co., Waterford, X91 ER8E, Ireland
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Taktak S, El-Taji O, Hanchanale V. Modern methods in managing urachal adenocarcinoma. Curr Urol 2023; 17:188-192. [PMID: 37448609 PMCID: PMC10337813 DOI: 10.1097/cu9.0000000000000189] [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: 05/07/2022] [Accepted: 11/13/2022] [Indexed: 03/12/2023] Open
Abstract
Objectives We sought to evaluate modern diagnostic and treatment options for urachal adenocarcinoma (UAC) and to provide clarity regarding the available options and their outcomes for this poorly understood yet damaging disease. Material and methods We conducted a systematic literature search in PubMed and Medline focusing on updated management of UAC. Results Surgical intervention continues to be the mainstay of treatment for localized UAC. However, with the increased availability of molecular and genetic profiling, chemotherapy has consistently demonstrated promising response rates and survival outcomes, especially for a disease that commonly presents in a metastatic stage. The role of checkpoint inhibitors remains under investigation. Cross-sectional imaging is vital during postoperative surveillance. However, there may also be a role for the adoption of cystoscopy to detect bladder recurrence. Conclusions Although the importance of surgical resection remains unchanged, improved survival outcomes with chemotherapy have been found in small retrospective studies. Randomized trial data are required to further assess the influence of systemic treatment as a primary or adjuvant therapy. Moreover, a stringent follow-up regimen incorporating evaluation for distant and local recurrence of UAC must be evaluated and adopted.
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Affiliation(s)
- Samih Taktak
- Department of Urology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Urachal carcinoma: The journey so far and the road ahead. Pathol Res Pract 2023; 243:154379. [PMID: 36821941 DOI: 10.1016/j.prp.2023.154379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Urachal carcinoma, a rare cancer arising from urachus, accounts for about 1% of bladder cancer. The diagnosis at stage I shows about 63% 5-year survival whereas only 8% of the patients at stage IV shows a 5-year survival. Above 90% of urachal carcinomas are adenocarcinomas and most of the urachal carcinoma cases are invasive, showing a high resemblance to adenocarcinoma of various origins, making it hard for a conclusive diagnosis. Even though inconclusive, immunohistochemistry can play a significant role in identifying urachal carcinoma. Most cases show the biomarkers CK20 and CDX2, whereas CK7 and β-catenin are expressed at a lesser frequency. Due to the few cases available, there is a lack of evidence regarding specific markers differentiating urachal carcinoma from colorectal or primary bladder adenocarcinomas. In addition to immunohistochemistry, genomic characterization is emerging to play a role in the classification and treatment of the disease. Urachal carcinoma has been reported to have a molecular level similarity with colorectal malignancies regarding certain gene expressions. The TP53 mutations inactivating the tumor suppressor can probably be explored as a possible target in treating urachal carcinoma. Additionally, certain targets identified in gastric and breast cancer along with anti-HER2 treatment strategies can be explored. Immuno-oncology utilizes immune checkpoint inhibitors for the treatment of MSI-H tumors whereas a combination of tyrosine kinase inhibitors along with immune checkpoint inhibitors are being studied to treat MSI stable tumors. The article is an in-depth overview of urachal carcinoma addressing the current landscape with an emphasis on the future scenario.
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Demographic profiles and survival outcomes of patients with urachal adenocarcinoma: a rare tumor of the urachal remnant. Clin Genitourin Cancer 2022. [DOI: 10.1016/j.clgc.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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Martins AR, Frazão J, Nogueira S, Godinho A. Atypical Presentation of a Urachal Carcinoma as an Enterocutaneous Fistula. Cureus 2022; 14:e23697. [PMID: 35505719 PMCID: PMC9056061 DOI: 10.7759/cureus.23697] [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] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
Urachal carcinoma is a rare and aggressive tumor, involving the urachus and the bladder. Symptoms of urachal carcinoma usually appear at later stages of the disease; therefore, these tumors are diagnosed in advanced stages, providing limited options for curative treatment. We report the clinical case of a 60-year-old man with a urachal carcinoma which presented as a mass of the abdominal wall invading the transverse colon, creating an enterocutaneous fistula. The patient underwent an en-bloc resection of the mass, segmentary resection of the transverse colon, and partial cystectomy.
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Affiliation(s)
| | - Joana Frazão
- General Surgery, Hospital Professor Doutor Fernando Fonseca, Lisboa, PRT
| | - Sara Nogueira
- General and Colorectal Surgery, Clinical Institute of Digestive and Metabolic Diseases, Hospital Clínic, Barcelona, ESP
| | - António Godinho
- General Surgery, Hospital Professor Doutor Fernando Fonseca, Lisboa, PRT
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Andersen JD, Fabrin K, Petersen A, Zacho HD. 18F-FDG PET/CT in a Case of Urothelial Carcinoma in the Urachus Presenting as Colon Cancer. Diagnostics (Basel) 2021; 12:diagnostics12010031. [PMID: 35054198 PMCID: PMC8774599 DOI: 10.3390/diagnostics12010031] [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: 11/15/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Urachal cancer arises from an embryologic remnant of the urogenital sinus and allantois and accounts for approximately 1% of bladder malignancies. The most encountered histologic subtype is adenocarcinoma. We present a 76-year-old man suspected to have an advanced sigmoid cancer infiltrating nearby organs. A supplemental 18F-FDG PET/CT showed high tracer uptake in a tumorous process coherent with the dome of the bladder wall involving the sigmoid colon. Cystoscopy revealed a normal bladder wall, except for a small edematous area in the anterior bladder. Biopsies from the sigmoid colon and transurethral resection from the bladder confirmed a urothelial carcinoma originating from the urachus.
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Affiliation(s)
- Jeannette D. Andersen
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Department of Clinical Medicine, Clinical Cancer Research Center, Aalborg University, 9000 Aalborg, Denmark
- Correspondence: ; Tel.: +45-9766-5500; Fax: +45-9766-5501
| | - Knud Fabrin
- Department of Urology, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Astrid Petersen
- Department of Pathology, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Helle D. Zacho
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Department of Clinical Medicine, Clinical Cancer Research Center, Aalborg University, 9000 Aalborg, Denmark
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Chen M, Xue C, Huang RQ, Ni MQ, Li L, Li HF, Yang W, Hu AQ, Zheng ZS, An X, Shi Y. Treatment Outcome of Different Chemotherapy in Patients With Relapsed or Metastatic Malignant Urachal Tumor. Front Oncol 2021; 11:739134. [PMID: 34604084 PMCID: PMC8479186 DOI: 10.3389/fonc.2021.739134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background Malignant urachal tumor is a rare subtype of genitourinary cancer. Our aim was to explore the optimal chemotherapy regimens for relapsed or metastatic urachal carcinoma. Materials and Methods We retrospectively enrolled 24 adult patients with relapsed or metastatic urachal carcinoma from January 2014 to September 2020 at Sun Yat-sen University Cancer Center. We summarized the chemotherapy regimens and classified them as fluorouracil based, platinum based, and paclitaxel based. Nine patients received XELOX (capecitabine and oxaliplatin) regimens, seven patients received TX (paclitaxel and capecitabine) regimens, and eight of them received chemotherapy including GP (gemcitabine and cisplatin), TP (paclitaxel and cisplatin), TN (paclitaxel and nedaplatin), and tislelizumab. Results The disease control rate was 75%. Among all patients, one patient treated with XELOX achieved partial remission (PR), while 17 patients showed stable disease. The median progression-free survival (PFS) and overall survival (OS) in all treated patients was 7.43 and 29.7 months, respectively. The patients receiving first-line platinum-based chemotherapy presented better PFS than those without platinum (median PFS 8.23 vs. 3.80 months, p = 0.032), but not significant for OS between two groups. There is no significant difference in PFS and OS for fluorouracil-based and paclitaxel-based groups as first-line regimen. Next-generation gene sequencing revealed TP53 mutation and low tumor mutational burden in five out of seven cases. Conclusion The platinum-based chemotherapy regimen is effective for relapsed or metastatic urachal carcinoma.
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Affiliation(s)
- Meiting Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Cong Xue
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ri-Qing Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Meng-Qian Ni
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lu Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hai-Feng Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - An-Qi Hu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhou-San Zheng
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin An
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yanxia Shi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Jia Z, Chang X, Li X, Wang B, Zhang X. Urachal Carcinoma: Are Lymphadenectomy and Umbilectomy Necessary? Med Sci Monit 2020; 26:e927913. [PMID: 32958737 PMCID: PMC7519942 DOI: 10.12659/msm.927913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/08/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim of this study was to explore the impact of lymphadenectomy and umbilectomy on long-term survival and progression-free survival (PFS) of patients with urachal carcinoma. MATERIAL AND METHODS We performed a retrospective analysis of 39 patients with urachal carcinoma. Clinicopathologic outcomes were evaluated, and overall survival (OS) and PFS were assessed by Kaplan-Meier method and Cox regression analysis. RESULTS Thirty-four (87.2%) patients underwent partial cystectomy, and 3 (7.7%) patients underwent radical cystectomy with en bloc urachal resection. Eighteen (46.2%) patients underwent lymphadenectomy and 27 (69.2%) patients had umbilectomy. Multivariate analysis showed that tumor size (P=0.011), Mayo stage (P=0.012), and umbilectomy (P=0.007) were the independent prognostic factors for OS. The median overall survival time was 67 months. The differentiation degree of tumor (P=0.049), Mayo stage (P=0.004), and umbilectomy (P=0.046) were the independent prognostic factors for PFS. Lymph node resection was not a predictor of OS. Patients had poorer prognosis when the tumor invaded the entire wall, including the mucous layer, muscular layer, and serous layer of the bladder compared with those that invaded only the muscular layer (P=0.014). CONCLUSIONS Lymph node metastases and failure to undergo umbilectomy were the independent prognostic factors for OS and PFS. Lymph node resection was not a predictor of OS. Patients had poorer prognosis when the tumor invaded the entire wall of the bladder compared with those that invaded the muscular layer.
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Abstract
PURPOSE OF REVIEW The aim of this review is to sum up the state of the art of urachal carcinoma (UC) in order to easily guide clinicians. RECENT FINDINGS UC is a rare and aggressive disease with consequent few data about diagnosis and treatment. Dates are mainly based on retrospective trial and case reports with limited prospective trial. Clinical presentation is not specific, often with urinary symptoms. Diagnosis is mainly based on CT scan and MRI, useful to evaluate local invasion and nodal status and to detect the presence of distant metastases. Therefore, biopsy is needed to obtain histological confirmation. Surgery is the gold standard for localized disease, while different chemotherapy schemes have been used in metastatic setting. Novel findings based on mutational analysis of the tumor include the use of biological treatment, such as cetuximab, and immunotherapy, such as atezolizumab, with satisfactory responses, suggesting that personalized treatment could be the most suitable option for UC.
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Chen X, Kang C, Zhang M. Imaging Features of Urachal Cancer: A Case Report. Front Oncol 2019; 9:1274. [PMID: 31850195 PMCID: PMC6901919 DOI: 10.3389/fonc.2019.01274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022] Open
Abstract
Urachal adenocarcinoma originates from the space of Retzius. It is a rare but aggressive neoplasm. Typical imaging findings of urachal cancer are difficult to find; this report provides an ultrasonographic (US) and computed tomographic (CT) description of the above. We present a case of a 45-year-old male patient presenting with painless hematuria of 1 week's duration and display the US and CT images. Imaging shows: (1) a solid, ill-defined, irregularly shaped mass invading the bladder wall located between the dome of the bladder and the abdominal wall, and which underwent significant enhancement; (2) hypo-echoic, heterogeneous echopattern with some calcifications and (3) patchy and short-line blood flow signals within the mass. Final histopathology confirmed urachal adenocarcinoma.
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Affiliation(s)
- Xiaoyan Chen
- Department of Ultrasound, Shanxi Academy of Medical Sciences, Shanxi DAYI Hospital, Taiyuan, China
| | - Chunsong Kang
- Department of Ultrasound, Shanxi Academy of Medical Sciences, Shanxi DAYI Hospital, Taiyuan, China
| | - Mingxia Zhang
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences, Shanxi DAYI Hospital, Taiyuan, China
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Abstract
Urachal anomalies are classified into four types depending on the level of persistence of the embryonic urachal remnants between the urinary bladder and the umbilicus: patent urachus, umbilical-urachal sinus, urachal cyst, and vesico-urachal diverticulum. Due to the increasing use of cross-sectional imaging, urachal anomalies are frequently detected as incidental findings. Imaging plays a pivotal role in the initial diagnosis, evaluation of complications, treatment follow-up, and long-term surveillance of patients with urachal anomalies. Different urachal anomalies demonstrate characteristic imaging features that aid in a timely diagnosis and guide treatment. A patent urachus is visualized as an elongated tubular structure between the umbilicus and the urinary bladder. While umbilical-urachal sinus appears as focal dilatation at the umbilical end of the urachal remnant, the vesico-urachal diverticulum presents as a focal outpouching of the urinary bladder at anterosuperior aspect. Urachal cysts are identified as midline fluid-filled sacs most frequently located near the dome of the urinary bladder. Untreated urachal anomalies could progress into potential complications, including infection and malignancy. Knowledge regarding imaging features of urachal anomalies helps in timely diagnosis, treatment, follow-up, and early detection of complications.
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Urachal carcinoma: from gross specimen to morphologic, immunohistochemical, and molecular analysis. Virchows Arch 2018; 474:13-20. [PMID: 30302546 DOI: 10.1007/s00428-018-2467-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/23/2018] [Accepted: 09/30/2018] [Indexed: 12/26/2022]
Abstract
Urachal carcinoma (UrC) is an exceedingly rare neoplasm that develops from the urachus, an embryologic remnant of the urogenital sinus and allantois. The most commonly encountered histologic subtype is adenocarcinoma. The aim of this study is to characterize a series of UrC by morphology, immunohistochemistry, and molecular analysis. We retrospectively investigated seven cases of UrCs and assessed patient symptoms, imaging, histologic features, immunohistochemical profile, molecular characteristics, pathologic stages, and type of treatment. Immunostaining for CK7, CK20, Muc-2, CDX2, GATA3, β-catenin, and CK34βE12 was carried out on each neoplasm and on seven non-neoplastic urachal remnants as the control group. Additionally, a mutational analysis was performed using the QIAact Actionable Insights Tumor Panel Kit, which analyzes KRAS, NRAS, KIT, BRAF, PDGFRA, ALK, EGFR, ERBB2, PIK3CA, ERBB3, ESR1, and RAF1. Our cohort comprised five females and two males with a mean age of 64 years. UrCs consisted of two mucinous cystadenocarcinomas and five invasive, non-cystic adenocarcinomas. Carcinoma antigen expression profile was positive for CK20 and negative for CK34βE12 and GATA3 in all cases. Five of seven cases stained positively for Muc-2 and CDX2. On the contrary, non-neoplastic urachal remnants were immunoreactive for CK34βE12, CK7, and GATA3. Mutational analysis gave a positive result in four out of seven (57.1%) cases. All four positive tumors showed RAS mutation and one an additional mutation in PIK3CA. Urachal tumors exhibit peculiar morphologic, immunohistochemical, and molecular features. Due to the advanced stage at presentation, individualized treatment should be undertaken.
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Reis H, Krafft U, Niedworok C, Módos O, Herold T, Behrendt M, Al-Ahmadie H, Hadaschik B, Nyirady P, Szarvas T. Biomarkers in Urachal Cancer and Adenocarcinomas in the Bladder: A Comprehensive Review Supplemented by Own Data. DISEASE MARKERS 2018; 2018:7308168. [PMID: 29721106 PMCID: PMC5867586 DOI: 10.1155/2018/7308168] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/06/2018] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Henning Reis
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Ulrich Krafft
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Christian Niedworok
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Orsolya Módos
- Department of Urology, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
| | - Thomas Herold
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Mark Behrendt
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, 45147 Essen, Germany
- Department of Urology, Semmelweis University, Üllői út 78/b, 1082 Budapest, Hungary
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Malignant urachal neoplasms: A population-based study and systematic review of literature. Urol Oncol 2017; 35:33.e11-33.e19. [DOI: 10.1016/j.urolonc.2016.07.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 01/16/2023]
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Paschke L, Juszczak M, Slupski M. Surgical treatment of recurrent urachal carcinoma with liver metastasis: a case report and literature review. World J Surg Oncol 2016; 14:296. [PMID: 27894318 PMCID: PMC5126806 DOI: 10.1186/s12957-016-1057-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Urachal carcinoma is a rare malignancy with poor prognosis due to late presentation of the disease and its aggressiveness. Surgery remains the mainstay of therapy even in cases of disease recurrence. To the best of our knowledge, this is the first report of salvage surgery in the case of urachal carcinoma with liver metastasis. Case presentation The patient was a young woman who suffered from locally advanced urachal carcinoma treated with en-bloc cystectomy, hysterectomy with bilateral adnexectomy, partial resection of the sigmoid colon, and partial resection of the rectus abdominis muscle with the fascia, skin, and umbilicus. Adjuvant chemotherapy with paclitaxel and carboplatin was applied. Two years after the treatment, she was diagnosed with a single liver metastasis and a local pelvic recurrence. In a two-step operation, the patient underwent right hemihepatectomy as well as resection of pelvic recurrence site and adjuvant chemotherapy with gemcitabine. Due to the disease progression, a complete resection of the lesions was not achieved and the response to chemotherapy was poor. The patient died of the disease after a year. Conclusions Surgery is the first line of treatment for urachal carcinoma and should be always considered as an option in cases of disease recurrence. Radical initial surgical management, close patient surveillance, and prompt treatment of disease relapse may all contribute to prolonging patient’s survival.
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Affiliation(s)
- Lukasz Paschke
- Department of Liver and General Surgery, Nicolaus Copernicus University, Curie-Sklodowskiej 9, Bydgoszcz, 85-094, Poland. .,Department of Urology, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Miroslaw Juszczak
- Department of Liver and General Surgery, Nicolaus Copernicus University, Curie-Sklodowskiej 9, Bydgoszcz, 85-094, Poland
| | - Maciej Slupski
- Department of Liver and General Surgery, Nicolaus Copernicus University, Curie-Sklodowskiej 9, Bydgoszcz, 85-094, Poland
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Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH. Imaging of the Urachus: Anomalies, Complications, and Mimics. Radiographics 2016; 36:2049-2063. [DOI: 10.1148/rg.2016160062] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Collins DC, Velázquez-Kennedy K, Deady S, Brady AP, Sweeney P, Power DG. National Incidence, Management and Survival of Urachal Carcinoma. Rare Tumors 2016; 8:6257. [PMID: 27746878 PMCID: PMC5064294 DOI: 10.4081/rt.2016.6257] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/31/2022] Open
Abstract
Urachal carcinoma is an uncommon cancer whose rarity has precluded its study and evidence-based management strategies are lacking. This study assessed all urachal carcinomas in Ireland and clinical parameters in order to improve understanding. Urachal carcinomas diagnosed from 1994 to 2011 were identified from the National Cancer Registry in Ireland. Data obtained included patient age, gender, diagnostic year, pathology, tumor stage, patient treatment strategies and survival. Twenty-six urachal carcinomas were identified, the majority being adenocarcinoma. This comprised 0.3% of all invasive bladder tumors. Patients were predominantly male (62%) and over 50 years of age (58%). Twenty-two patients (85%) underwent surgery, with only six (23%) undergoing chemotherapy. On average, median overall survival was 2.6 years (range 0-15.2 yrs). Survival was longer in women (5 vs. 1.9 yrs), patients under 50 years of age (3.6 vs. 1.9 yrs), those without confirmed metastasis (4.1 vs. 0.7 yrs) and those who received chemotherapy (3.6 vs. 2.6 yrs). The overall survival of urachal carcinoma in Ireland is less than expected from published literature. This study highlights the need for centralization of rare tumors with international collaboration to identify the optimal treatment strategy and improve outcome.
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Affiliation(s)
| | | | - Sandra Deady
- National Cancer Registry Ireland , Cork, Ireland
| | - Adrian P Brady
- Department of Radiology, Mercy University Hospital , Cork, Ireland
| | - Paul Sweeney
- Department of Uro-Oncological Surgery, Mercy University Hospital , Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Cork University Hospital , Cork, Ireland
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Clinical, prognostic, and therapeutic aspects of urachal carcinoma—A comprehensive review with meta-analysis of 1,010 cases. Urol Oncol 2016; 34:388-98. [DOI: 10.1016/j.urolonc.2016.04.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 12/23/2022]
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Dekeister K, Viguier JL, Martin X, Nguyen AM, Boyle H, Flechon A. Urachal Carcinoma with Choroidal, Lung, Lymph Node, Adrenal, Mammary, and Bone Metastases and Peritoneal Carcinomatosis Showing Partial Response after Chemotherapy Treatment with a Modified Docetaxel, Cisplatin and 5-Fluorouracil Regimen. Case Rep Oncol 2016; 9:216-22. [PMID: 27194981 PMCID: PMC4868939 DOI: 10.1159/000444787] [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] [Indexed: 11/19/2022] Open
Abstract
Urachal carcinoma (UC) is a rare tumor mainly affecting middle-aged males. Metastases occur most frequently in lymph nodes and the lungs. There are no standard adjuvant and metastatic treatments. We report the case of a 36-year-old female with UC treated with partial cystectomy who relapsed 3 years after surgery with left choroidal, lung, mediastinal lymph node, right adrenal, mammary, and bone metastases as well as peritoneal carcinomatosis. She obtained a partial response after 10 cycles of chemotherapy with a modified docetaxel, cisplatin and 5-fluorouracil (mTPF) regimen. This is the first report on the use of the mTPF regimen in UC and on the existence of choroidal, adrenal, and mammary metastases.
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Thirunavukkarasu B, Mridha AR, Yadav S, Kumar R, Gamanagatti S. Fine Needle Aspiration Cytology Diagnosis of an Urachal Adenocarcinoma. J Clin Diagn Res 2016; 10:ED10-2. [PMID: 27190817 DOI: 10.7860/jcdr/2016/16115.7586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/05/2016] [Indexed: 11/24/2022]
Abstract
Urachal Carcinoma (UC) is a rare malignancy of urinary bladder. It is usually found in adults in advanced stages because the tumour often grows outside the bladder without producing clinical symptoms. Most of the cases are mucinous, intestinal or signet ring cell adenocarcinoma and the diagnosis is usually made on biopsy. Radiographic images of this tumour may show characteristic features with a midline solid or cystic mass in the anterior wall of bladder associated with small calcification, which is considered as a pathognomonic sign for the diagnosis of UC. We report a case of UC in an adult, whose radiographic images suggested an urachal tumour and Fine Needle Aspiration (FNA) cytology revealed an adenocarcinoma. Laparoscopic partial cystectomy with umbilectomy and pelvic node dissection was done without further histopathological confirmation. Surgical intervention of UC on the basis of FNA diagnosis has not been reported in the literature.
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Affiliation(s)
| | - Asit Ranjan Mridha
- Assistant Professor, Department of Pathology, All India Institute of Medical Sciences , New Delhi, India
| | - Siddharth Yadav
- Postgraduate Student, Department of Urology, All India Institute of Medical Sciences , New Delhi, India
| | - Rajeev Kumar
- Professor, Department of Urology, All India Institute of Medical Sciences , New Delhi, India
| | - Shivanand Gamanagatti
- Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences , New Delhi, India
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