YO14 - Urachal Adenocarcinoma: Case Report

Case summary

Urachal cancer is a rare neoplasm which represents approximately 0.5-2% of all bladder cancer.

A 52 year old Filipino male presented with painless hematuria. Physical examination was unremarkable. KUB ultrasound showed a bladder mass so Cystoscopy–TUR was done. Histopathology revealed adenocarcinoma with involvement of muscularis propria. He was advised surgery but did not consent. Contrast-enhanced abdominal computed tomography (CT) showed a well-defined, slightly wall enhancing, midline infraumbilical complex soft tissue mass measuring 3.6x4.0x5.1cm in the anterosuperior aspect of the urinary bladder extending to the urachus with no communication to the umbilicus. Cystoscopy, Partial Cystectomy with Umbilectomy was done. Intra-operative findings: bladder mass at the dome approximately 2-3cm in size, necrotic tissue with band of tissue directly connected to the umbilicus. Histopathology was urachal adenocarcinoma which extends to the urinary bladder muscularis propria and perivesical tissue. He was advised close follow-up.

After one year, he started to experience difficulty initiating urine. Repeat CT scan showed: urinary bladder with an intraluminal enhancing nodule in the superoanterior wall measuring 1.5x1.7cm, irregular anterior urinary bladder wall thickening measuring 7.3x1.5cm is also noted, small anterior perivesical nodes are noted measuring 0.7x1.2 cm. Cysto-TURP of Bladder Tumor, Exploratory Laparotomy, Adhesiolysis, was done. Intra-operative findings were: smooth urethral mucosa without stenosis or stricture; pedunculated broad-based, friable, pink fleshy mass seen at the posterolateral bladder wall, measuring 5-8 cm in greatest diameter; flat erythematous lesion measuring 2cm noted at bladder dome; muiltiple nodularities along peritoneum with some attached to ileal loops. Specimen’s pathology reported adenocarcinoma and peritoneal nodularities were metastatic adenocarcinoma; morphological features favored the diagnosis of urachal adenocarcinoma. CT scan of the Chest showed innumerable varisized non-calcified parenchymal, fissural, and subpleural nodules scattered in both lungs which were worrisome for metastasis. The patient has received systemic chemotherapy with Cisplatin and Fluorouracil.

Clinical trial identification

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