A 61-year-old man, presented with painless gross hematuria and palpable mass at suprapubic area. Computed tomography (CT) of abdomen showed enhancing mixed solid-cystic mass size 4 x 3.6 cm originating at the right anterior dome of bladder. He underwent exploratory laparotomy with partial cystectomy with urachal excision. Histopathology reported adenocarcinoma, margin is not free. Immunohistochemistry staining showed positive CK20, CDX2, focally positive CK7 and negative PSA. He was diagnosed with urachal carcinoma stage IIIA by Sheldon et al. classification. That time he did not received any adjuvant chemotherapy and radiotherapy. Five months later, he developed recurrent suprapubic area mass and painless gross hematuria. His physical examination of abdomen showed palpable lobulated fixed hard consistency mass at dome of bladder to lower midline of abdomen. CT of abdomen showed enhancing nodule at the left anterior-inferior aspect of the bladder, and hypodense lesion on midline surgical scar at lower abdomen. He was diagnosed with recurrent locally advanced urachal carcinoma stage IIIB. He was treated by pre-operative concurrent chemoradiotherapy(CCRT) with 5-Flurouracil(5FU) with 350 mg/m2day 1-5 and day 28-33. CT of the abdomen after completion of CCRT showed decreasing size of nodular thickening at the left anterolateral aspect of bladder from 2.8 cm to 1.3 cm (17.8%), no substantial change in size of enhancing soft tissue mass on midline surgical scar. Then he was treated with exploratory laparotomy with tumor removal and partial cystectomy. Histopathology showed adenocarcinoma with mucin production, margin is not free. Multidisciplinary team decided to treat with adjuvant chemotherapy with 5FU-based regimen.
Urachal cancer is a very rare cancer carrying poor prognosis in genitourinary tract cancers. It may present with different clinical manifestations, including an abdominal mass, hematuria and pain. Surgical resection is a main strategy for treatment. There has been no standard regimen for neoadjuvant or adjuvant chemotherapy and radiotherapy. This case showed a favorable response from induction CCRT with 5-FU following by surgery in locally advance urachal adenocarcinoma.