Inflammatory pseudotumor of urachus mimicking invasive carcinoma of bladder

ALK-negative urachal inflammatory myofibroblastic tumor in an elderly female: A case report

RATIONALE

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue lesion, originally reported in the lungs. Occurrence of the IMT was also documented in the digestive system, but rare in the urinary system, especially in the urachus, and little is presently known about IMT.

PATIENT CONCERNS

This study reported a very rare case of urachal IMT in an elderly female patient at the age of 77 who was diagnosed with a lower abdominal mass 2 months ago.

DIAGNOSIS

The preoperative diagnosis was urachal carcinoma, which was confirmed to be anaplastic lymphoma kinase (ALK) negative urachal IMT by postoperative histopathology and immunohistochemistry tests.

INTERVENTIONS

Laparoscopic radical urachal carcinoma resection and partial bladder resection was performed under general anesthesia, and the tumor was completely removed.

OUTCOMES

There was no recurrence and metastasis over 22 months of follow-up.

LESSONS

The urachal IMT occurs mainly in males and nonelderly people with ALK positive while in females with ALK negative. The most common clinical manifestations of urachal IMT are lower abdominal masses; it is very important to distinguish whether the tumor originates from the bladder or the urachus, because the surgical treatment options are completely different. Currently the complete surgical removal of the tumor is the best treatment option for urachal IMT. No other adjuvant therapy is required after operation. All urachal IMT after follow-up showed no recurrence and metastasis, suggesting a good prognosis. However, IMT has malignant potential and it requires a long-term close follow-up check.

Biomarkers in Urachal Cancer and Adenocarcinomas in the Bladder: A Comprehensive Review Supplemented by Own Data

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.

Inflammatory myofibroblastic tumor with extensive involvement of the bladder in an adolescent: a case report

Inflammatory myofibroblastic tumor (IMT) is a rare lesion of unclear pathogenesis that shows a wide, highly variable spectrum of clinical behavior. We describe the case of a 17-year-old boy with a large IMT that infiltrated the bladder, ileocecal junction, peritoneum and pelvic retroperitoneal space. The tumor was associated with extensive toughening and thickening of the bladder, and, although it showed a tendency for invasive growth, it affected mainly the bladder and adjacent tissue. To the best of our knowledge, this case report is the first to describe an IMT involving the entire bladder and several adjacent pelviabdominal organs. The bladder wall was tough and could hardly be cut by scalpel. Levels of inflammatory response markers such as C-reactive protein fell after surgery.

Glucocorticosteroid-sensitive inflammatory eosinophilic pseudotumor of the bladder in an adolescent: a case report

Introduction

Inflammatory eosinophilic pseudotumor of the bladder is a rare inflammatory bladder disease. The etiology and pathophysiology of this condition are still unclear. Few case reports have described inflammatory eosinophilic pseudotumor of the bladder in adults or children. Although benign, this disease is occasionally clinically aggressive and locally invasive, thus open surgical removal or complete transurethral resection is recommended.

Case presentation

We present the case of a biopsy-proven inflammatory eosinophilic pseudotumor of the bladder in a previously healthy 16-year-old male adolescent with 2-month history of frequent micturition and dysuria with no significant apparent causative factors. The tumor regressed after a 6-week course of glucocorticosteroids.

Conclusion

To the best of our knowledge, our case is a rare case of inflammatory eosinophilic pseudotumor of the bladder treated with complete conservative management. Due to its glucocorticosteroid-sensitive nature, we postulate that this disease belongs to a subgroup of eosinophilic disorders.