Carcinoma of the urachus

Is excision necessary in the management of adult urachal remnants?: a 12-year experience at a single institution

OBJECTIVES

To determine the ideal management of uncomplicated adult urachal remnants and to confirm if conservative management with repeated imaging is acceptable.

PATIENTS AND METHODS

This is a retrospective review of clinical notes and imaging of 45 patients with a mean age of 54.6 years who had been diagnosed with urachal anomalies at a single urology tertiary centre from January 2005 to December 2016. Patients who underwent surgical intervention and findings from patients managed non-operatively, with a mean follow up of 31 months, were evaluated.

RESULTS

Thirty (66.7%) patients had incidental findings, while 15 (33.3%) were symptomatic. Eight underwent excision, one underwent an incision and drainage of abscess, while 34 of the 36 remaining patients elected to undergo surveillance with repeated ultrasound imaging. Two were lost to follow-up. Malignancy was confirmed in three patients. There was interval stability of the urachal remnant in all the patients in the non-operative cohort. The small sample size, limited follow-up, and retrospective nature of the study are recognised limitations.

CONCLUSIONS

It was found that simple and asymptomatic lesions can be monitored with ultrasound, but effort must be made on initial diagnosis to ensure that malignancy is excluded using CT imaging and flexible cystoscopy where possible. Long-term follow-up of this cohort is required to assess the natural history of observed urachal anomalies.

The Youngest Korean Case of Urachal Carcinoma

Urachal anomalies are relatively uncommon and result from incomplete obliteration of the urachus perinatally. In children, most urachal diseases including urachal cysts and sinuses are benign, and these can sometimes become secondarily infected. Malignant involvement of the urachus is rarely reported, one in 5 million people, accounting for 0.35% to 0.7% of all bladder cancers. There are only five cases of urachal cancer diagnosed at the age of twenties in English written literature. Age at the diagnosis of urachal carcinoma is important to understand pathogenetic transition from benign to malignancy. A 26-year-old man visited our clinic with gross hematuria starting a few months before. CT scan showed a 4.0 × 6.8 cm sized lobulated cystic mass over the bladder dome. Cystoscopy showed a ball-shaped extrinsic mass from the bladder dome with intact bladder mucosa. With an impression of urachal cancer, laparoscopic partial cystectomy with wide excision of urachus was performed. Final diagnosis was well differentiated mucinous urachal adenocarcinoma invading bladder muscle, staged as pT3a based on Sheldon's staging system. To our best knowledge, this case is the youngest Korean case of urachal carcinoma (the fourth youngest ever in English written literature).

Primary Yolk Sac Tumor of the Urachus

Introduction. Neoplasms originating from the urachus are rare. The most common urachal malignancy is adenocarcinoma, whereas extragonadal germ cell tumors, primarily of the urachus, are an extremely rare finding. Objective. To describe a primary yolk sac tumor (YST) of the urachus in an adult. Case report. A 44-year-old woman presented with 6 months of pelvic pain associated with a sensation of progressive mass growth. At the time of tumor resection, the tumor was found to be attached by a pedicle to the dome of the bladder, with no injury to the adjacent organs. Pathological study showed a neoplasm with epithelioid cells, pseudocysts, a myxomatous background, and Schiller-Duval body formations. Immunohistochemistry stains showed positivity to AE1/AE3, α-1-fetoprotein, and α-1-antitrypsin and negativity to other markers. Conclusion. An unusual case of a YST in the urachus is presented. This is the first reported adult case based on the authors’ bibliographic search.

Recurrent urachal mucinous adenocarcinoma presenting as bilateral ovarian tumors on cesarean delivery

Secondary ovarian cancers, Krukenberg tumors, are a distinctive subset of metastatic tumors arising from the gastrointestinal tract (stomach, colon, and appendix), the biliary system, the breast, or other genital organs. These tumors account for 5% of all ovarian malignancies. Such metastases could mimic primary mucinous ovarian adenocarcinomas. Metastases from the urinary tract are uncommon. Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies; one third of these tumors are urachal in origin. Urachal cancers are rare and tend to occur in older men (mean age, 50-60 years); however, it was described previously in a 15-year-old girl. Symptoms include hematuria, dysuria, frequency, urgency, and recurrent urinary tract infections. These tumors have a predilection to locally spread to the surrounding organs. Ovarian metastasis is a rare event and is infrequently reported in literature.

Urachal Anomalies: A Longitudinal Study of Urachal Remnants in Children and Adults

PURPOSE

Urachal anomalies are often recognized in children but they may persist into adulthood and cause considerable morbidity. We reviewed the clinical findings associated with these embryological structures and evaluated risk factors for cancer to define the optimal timing for intervention.

MATERIALS AND METHODS

We examined the medical records of 176 patients diagnosed with a urachal anomaly between 1951 and 2005. Association of clinicopathological features with malignancy for adults was evaluated using univariate and multivariate logistic regression studies.

RESULTS

Urachal remnants were identified in 46 children and 130 adults. Of the 46 children 20 (43%) presented with umbilical drainage and 23 (50%) could be diagnosed by physical examination. A total of 34 children (74%) underwent simple excision. In contrast, 65 of the 130 adults (50%) presented with hematuria, 78 (60%) required cystoscopy and 53 (41%) required computerized tomography. A total of 66 adults (51%) required more extensive surgical intervention with partial or radical cystectomy. Of adult urachal anomalies 66 (51%) were malignant. Patient age 55 years or older and hematuria were the strongest predictors of urachal malignancy (each p <0.001). Cancer risk increased with advancing adult age.

CONCLUSIONS

Urachal anomalies present and progress differently in pediatric and adult populations. Adults are at high risk for urachal cancer but children usually incur lower morbidity. Urachal lesions noted early in childhood should be excised to prevent problems in adulthood.

Urachal carcinoma: clinicopathologic features and long-term outcomes of an aggressive malignancy

BACKGROUND

Urachal carcinoma (UrC) is a rare malignancy, and patients with this disease have a poor prognosis. In this article, the authors report 50 years of experience with this tumor at the Mayo Clinic.

METHODS

A urachal mass was described in 130 patients, and 66 of those masses were malignant. The authors identified multivariate predictors of malignancy in clinically diagnosed urachal masses and predictors of UrC-specific survival. This report presents a novel 4-category staging system for UrC along with the treatment history of this tumor and the results of salvage therapy.

RESULTS

Twenty women and 46 men were identified with UrC. The strongest predictors of malignancy in a urachal mass were hematuria and age older than 55 years. The 5-year cancer-specific survival rate was 49%. The new Mayo staging system was less complicated than the Sheldon system, although both systems predicted cancer-specific mortality equally well. Positive surgical margins (hazard ratio [HR], 4.7), high tumor grade (HR, 3.6), positive local lymph nodes (HR, 5.1), metastases at diagnosis (HR, 3.3), advanced tumor stage (HR, 4.8), failure to perform umbilectomy (HR, 3.0), and primary radiation therapy (HR, 2.9) were all univariately associated with death (P <.05). Only grade and margins were significant in the multivariate analysis. No survival benefit was noted for lymphadenectomy or adjuvant therapy. Salvage surgery resulted in a long-term cure for 50% of patients who had local recurrences. No effective treatment was identified for patients with metastatic UrC.

CONCLUSIONS

Early and complete extended partial cystectomy, including umbilectomy, is critical to the survival of patients with UrC. The authors recommend using the Mayo staging system in future studies because of its simplicity. The current results indicated that the most important predictors of prognosis were tumor grade and surgical margin status.

Urachal Carcinoma: Key Points for the General Surgeon

Urachal carcinoma is a rare neoplasm with the majority of cases reported in the urologic literature. Because of its presentation as an intra-abdominal mass with involvement of adjacent structures the general surgeon may be consulted early in the diagnostic evaluation. One should be aware of this entity as early recognition and appropriate surgery provides the best opportunity for long-term survival. Herein we describe a typical case, appropriate evaluation, and review of the literature.

Successful chemotherapy in a patient with recurrent carcinoma of the urachus

Urachal neoplasm generally has a poor prognosis, because of long latency period, extravesical progression and pathological predominant pattern of adenocarcinomas. We report a case of recurrent poorly differentiated carcinoma of urachal remnant, which responded well to combination systemic chemotherapy (methotrexate, vinblastine, doxorubicin and cisplatin: M-VAC). Our case was possibly of transitional cell origin. The patient has been symptom-free even 13 months after the first chemotherapy course.

Urachal cancer: role of conservative surgery

Urachal carcinoma is a rare neoplasm (0.22% of all bladder cancers) associated with a dismal prognosis. The obscure anatomic position of the tumor often minimizes early symptoms and precludes a timely diagnosis. The reported survival for urachal neoplasms has been inauspicious, and radical surgery (en bloc cystoprostatectomy and wide excision of the urachus and umbilicus) has been recommended as the primary treatment. To provide a rationale for the surgical management of this cancer, 38 patients with urachal carcinoma were reviewed, including 28 men and 10 women (2.8:1) (median age at diagnosis, 56 years; range, 28 to 88 years). The majority of the tumors were of high grade and stage at the time of diagnosis; they were exclusively DNA aneuploid in the 10 patients studied. Most patients had partial (segmental) cystectomy/umbilectomy (n = 30) or en bloc radical cystoprostatectomy/umbilectomy (n = 4) as their initial treatment; five-year overall survival of 43 percent and 50 percent revealed essentially comparable outcomes for the two surgical approaches. Thus, in the initial management of urachal carcinoma, umbilectomy with partial cystectomy may be considered in selected cases; this can enhance quality of life without necessarily influencing survival adversely. Rather, disease outcome seems more dependent on the adverse biologic potential of this usually DNA aneuploid tumor, necessitating the development of more innovative systemic treatment modalities.

A case of urachal carcinoma

Urachal carcinoma is an uncommon tumor, with a poor prognosis. The most common histological type is adenocarcinoma, which may produce mucus. The symptoms aren't specific, such as hematuria or abdominal mass. Diagnosis can be made endoscopically with a biopsy or by echography and above all by computerized tomography. The treatment of choice is cystectomy with lymphadenectomy or segmental resection of the bladder to. The Authors refer to a patient with urachal carcinoma, stage IIIA involving the bladder.

Carcinoma of the Urachus. Report of a Case

The authors report a case of urachal carcinoma of a 60 year old woman of particular interest because of the clinical history, biological behavior and histotype. The tumor presented as an umbilical mass of 25 cm which had slowly increased during 20 years without evident clinical signs or infiltration of the peritoneum and abdominal organs. Histologic findings revealed an adenosquamous carcinoma, which represents less than 5 % of urachal neoplasms. Surgical excision is the treatment. The prognosis is poor because of regional recurrence and metastases. The authors review the literature analyzing the criteria for differential diagnosis between adenocarcinoma of vesical and of urachal origin.

Urachal carcinoma: evaluation with computed tomography

The computed tomographic (CT) findings in 7 patients with urachal carcinoma were reviewed. Computed tomography was useful in establishing an initial diagnosis, determining the tumor extent, and visualizing tumor recurrence. The embryology, histology, and clinical course of urachal carcinoma are reviewed.

Squamous cell carcinoma of the urachus. A case report and review of literature

A rare case of squamous cell carcinoma (SCC) is reported. A cystic tumor, measuring 4 X 4 cm was surgically removed from the supravesical portion in a 77-year-old woman. Macroscopically, it had a communicating canal to the urinary bladder. Microscopically, well differentiated squamous cell carcinoma with pearl formation was noted. An aspiration biopsy was helpful for the histopathological diagnosis at operation. The patient developed purulent peritonitis because of rupture of the tumor which was vulnerable to infection. Six documented cases and the present case were reviewed. The tumors were classified into two types on morphological features: supravesical type and intramural type. Site and local extension of the tumor accounted for clinical features of each type. The authors considered that SCC cells were derived from totipotential epithelial lining of the urachal remnant.

Computed tomographic imaging of microscopic dystrophic calcification in urachal adenocarcinoma

Supravesical calcification noted on conventional radiography when associated with a bladder lesion has been considered nearly pathognomonic of the uncommon lesion, urachal adenocarcinoma. As the case reported here demonstrates, stippled microscopic calcification undetected by conventional means can be demonstrated uniquely by computed tomography with great sensitivity. Because urachal adenocarcinoma may be managed in a distinctly different manner if adequate preoperative preparation is made, it is suggested that in cases of anterior bladder lesions, computed tomographic imaging can detect this typical characteristic of urachal adenocarcinoma and may thereby provide further comfirmatory diagnostic evidence helpful in surgical planning.

Urachal carcinoma

Urachal carcinoma is a rare tumor that often does not manifest clinically until late in its course. Several radiographic features are helpful in suggesting the diagnosis preoperatively. We present a case of urachal carcinoma in which preoperative evaluation included magnetic resonance imaging. This technique was helpful not only in suggesting the diagnosis preoperatively, but also, and more importantly, in the preoperative staging of the neoplasm.

Urachal adenocarcinoma presenting as vesicoenteric fistula

We report a case, which we believe to be the first, of urachal carcinoma presenting as vesicoenteric fistula.

Adenocarcinoma of the urachus with vesicoenteric fistula

A case of mucoid adenocarcinoma of the urachus demonstrated by ultrasonography, cystography, and computerized tomography is presented. The inhomogeneous, echogenic mass was confluent with the anterior--superior aspect of the bladder but was also associated with a fistula between the bladder and small intestine, a finding not previously reported.

Malignant urachal lesions

Urachal cancers are uncommon malignancies with a location that often permits considerable local extension before they are discovered. The most common histological type is adenocarcinoma, which may produce mucus that is a valuable aid in diagnosis. The presence of stippled calcification in a midline abdominal wall mass is almost pathognomonic for urachal carcinoma. More commonly, however, the symptoms are less specific, such as hematuria and an abdominal mass. Many lesions are visible endoscopically and, thus, the diagnosis can be made preoperatively from a biopsy. Most treatment failures occur because the tumor is not controlled locally by the initial operation and, therefore, we recommend en bloc cystectomy with umbilectomy and pelvic lymphadenectomy unless the tumor is known to be a sarcoma or early stage (I) carcinoma. If these patients are undertreated and there is a local recurrence then the patient usually is not salvageable. Because of the difficulty in identifying the origin of a bladder adenocarcinoma, any tumor on the dome or anterior wall should be approached initially as if it were a urachal tumor.

Clinical features of urachal carcinoma in Japan: review of 157 patients

Carcinoma of the urachus is not as uncommon as previously considered. 157 cases diagnosed to have urachal carcinoma collected from the Japanese literature were reviewed and the findings were compared with those reported in the English literature. The incidence of the disease ranges from 0.55 to 1.2% of bladder tumours in Japan in contrast with 0.07 to 0.70% in the Western countries. Males accounted for 72% of the patients. The highest age incidence occurred between fifth and sixth decades. The commonest presenting symptom was haematuria (71%). Adenocarcinoma accounted for 88% of the tumours most being mucous producing. Various treatment modalities were used, however, and the prognosis remained uniformly poor. An analysis of 66 patients with known outcome revealed an overall 5-year survival rate of 6%. The authors conclude that the disease tends to have a relatively higher incidence in Japan (Far East). When comparing the parameters of sex, age, presenting symptom, histopathology, treatment and prognosis, urachal carcinoma appears to have the same characteristics in the Far East as in Western countries.

Adenocarcinoma of urachus. Report of 7 cases and review of literature

Seven cases of adenocarcinoma of the urachus treated at the National Cancer Center Hospital, Tokyo, over a nineteen-year period are reported. One hundred fifty-five cases reported in English literature and 140 cases in Japanese literature were analyzed with respect to the modalities of treatment, mean remission times, and sites of recurrence or metastases. From this review and experience on the 7 cases reported here, extended radical total cystectomy with well-designed radio- and chemotherapy was proposed for the treatment of this disease.

Urachal carcinoma: diagnosis by computerized axial tomography

A case of mucin-producing adenocarcinoma of the urachus is reported. Preoperative diagnosis was established by computerized axial tomography. The embryology, histogenesis, signs, symptoms, diagnostic criteria and treatment are discussed.

Adenocarcinoma of the urachus

During the last 50 years 8 patients with adenocarcinoma of the urachus were managed at our hospital. The various modalities of therapy included radiation therapy, transurethral resection, segmental resection of the bladder and total cystectomy. A retrospective analysis of these cases is presented, including the histologic patterns, sites of spread and survival according to therapy.