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Bogaert B, Tulelli B, Rodesch M, Pregardien C, Rorive S, Lingier P. Urachal mucinous cystadenoma in infant: First case report in infant and review of literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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2
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Agnihotri AK, Yagnik VD, Agnihotri S, Yagnik B. Mucinous cystadenomas of urachus: A case report and literature review. Urol Ann 2020; 12:291-294. [PMID: 33100759 PMCID: PMC7546063 DOI: 10.4103/ua.ua_118_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 06/19/2020] [Indexed: 11/04/2022] Open
Abstract
Urachal epithelial neoplasms are rare tumors that arise from the vestiges of the urachus. Mucinous cystadenomas are considered as a benign glandular tumors of the urachus. Cystadenomas are commonly found in the ovary, appendix, and pancreas. Mucinous cystadenomas of the urachus are extremely rare in the urachus, and only nine cases reported so far. We reported the 10th case of Mucinous cystadenomas of the urachus detected incidentally at the time of diagnostic laparoscopy for investigation of genitourinary tuberculosis.
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Affiliation(s)
- Arun Kumar Agnihotri
- Department of Pathophysiology, American University of Antigua College of Medicine, Antigua, Antigua and Barbuda, India
| | - Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, India
| | - Smriti Agnihotri
- Department of Pathophysiology, American University of Antigua College of Medicine, Antigua, Antigua and Barbuda, India
| | - Bhargav Yagnik
- Consultant Pathologist, Neberg Supratech Laboratory, Mehsana, Gujarat, India
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3
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Urachal Mucinous Cystic Tumor of Low Malignant Potential with Concurrent Sigmoid Colon Adenocarcinoma. Case Rep Gastrointest Med 2019; 2019:1434838. [PMID: 31341685 PMCID: PMC6614953 DOI: 10.1155/2019/1434838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023] Open
Abstract
Urachal mucinous tumors are rare neoplasms with behaviour that can range from relatively benign to malignancy that can spread distantly or throughout the peritoneum as pseudomyxoma peritonei or peritoneal carcinomatosis. Here we describe a unique case of urachal mucinous cystic tumor of low malignant potential confined to an intact cyst at the dome of the urinary bladder, without rupture or peritoneal spread. The urachal mucinous tumor was an incidental finding on a staging CT scan performed for sigmoid colon adenocarcinoma. We believe that this case illustrates a potential diagnostic pitfall which could have prognostic and therapeutic implications. Due to the intestinal phenotype of these neoplasms, a urachal tumor of low malignant potential could be mistaken for metastatic spread from a colonic adenocarcinoma in the rare situation such as this case, where the two neoplasms occur concurrently.
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Wang D, Sule N. Mucinous Cystadenoma of the Urachus and Review of Current Classification of Urachal Mucinous Cystic Neoplasms. Arch Pathol Lab Med 2018; 143:258-263. [PMID: 30398914 DOI: 10.5858/arpa.2017-0319-rs] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Urachal neoplasms are uncommon and represent a minor portion of bladder tumors. According to the recently updated World Health Organization classification (2016), these tumors are classified as adenomas, adenocarcinomas, nonglandular neoplasms, and mixed carcinomas. The mucinous cystic neoplasms represent a small percentage of urachal tumors with morphologic spectrum ranging from benign mucinous cystadenoma to borderline mucinous cystic tumor of low malignant potential and to malignant mucinous cystadenocarcinoma. Benign urachal mucinous cystic adenomas are exceedingly rare, and only a few cases have been reported in the literature to date. The goal of this review is to summarize the clinical features, histopathologic characteristics, treatment, and prognosis of urachal mucinous cystadenoma in light of differentiating them from mucinous cystic tumor of low malignant potential and mucinous cystadenocarcinoma.
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Affiliation(s)
- Diping Wang
- From the Department of Pathology and Anatomical Science, State University of New York, Buffalo (Dr Wang); and the Department of Pathology, Roswell Park Cancer Institute, Buffalo (Dr Sule)
| | - Norbert Sule
- From the Department of Pathology and Anatomical Science, State University of New York, Buffalo (Dr Wang); and the Department of Pathology, Roswell Park Cancer Institute, Buffalo (Dr Sule)
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Abstract
RATIONALE Urachal borderline mucinous cystadenoma is very rare and has only 9 cases in the current literature with the biological behavior between adenoma and adenocarcinoma. PATIENT CONCERNS We reported a 41-year-old man with moderate lower abdominal pain, and the imaging examination found an irregular cystic lesion extending from umbilicus to the dome of urinary bladder with significant separations and calcifications. DIAGNOSES The diagnosis was confirmed according to the specific anatomical location and pathological examination which was proved as mucinous cystadenoma with low malignant potential. INTERVENTIONS The patient undertook radical excision and partial cystectomy. OUTCOMES His postoperative condition was good. LESSONS Urachal borderline mucinous cystadenoma can be located by image examination, which may also offer several diagnostic tips according to separation, calcification, and enhancement in computed tomography scan. When combined with pathological findings, qualitative diagnosis can be determined. Surgical resection should be chosen as an optimal treatment. Our present study reviewed the clinical and biological information of all previous cases which were diagnosed as urachal borderline mucinous cystadenoma and we supplemented more data for further study.
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Affiliation(s)
- Jingjun Wu
- Department of Radiology Department of Pathology, the First Affiliated Hospital of Dalian Medical University, Dalian Shi, Liaoning Sheng, China
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Zhao XR, Gao C, Zhang Y, Kong L, Qu W, Li J, Gao YS, Yu YH. Urachal adenocarcinoma that metastasized to breast was misinterpreted as primary breast mucinous carcinoma: A rare case report and literature review. Medicine (Baltimore) 2016; 95:e4612. [PMID: 27583877 PMCID: PMC5008561 DOI: 10.1097/md.0000000000004612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The urachus is a vestigial tubular structure that connects the urinary bladder to the allantois during early embryonic development. Urachal carcinoma develops in the urachus, which is an embryological remnant of the urogenital sinus and allantois. The estimated annual incidence of urachal carcinoma in the general population is 0.01% of all cancers in adults. Moreover, urachal carcinoma accounts for 0.34% to 0.7% of all bladder carcinoma cases. And breast metastasis is extremely rarer. METHODS AND RESULTS A 42-year-old woman was admitted to our hospital with a palpable mass in the outer upper quadrant of the right breast, which was misinterpreted as a carcinoma that originated from the breast. Subsequently, she underwent surgery without any further meticulous examination. Immunohistochemistry analysis revealed positivity for CK20, Villin, and CDX-2 and negativity for CK7. After further inspection, a mass was found in the bladder dome using 18F-fluorodeoxyglucose positron emission tomography and computed tomography. The mass was surgically removed. CONCLUSION Pathologic and immunohistochemical examination confirmed that the mass was urachal mucinous adenocarcinoma and mucinous adenocarcinoma to the right breast. The patient has been followed up without recurrence for 8 months.
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Affiliation(s)
- Xiang-Rong Zhao
- School of Medical and Life Sciences, Shandong Academy of Medical Sciences, Jinan University, Jinan, China
- Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University
| | - Chao Gao
- Department of Radiation Oncology, Affiliated hospital of Shandong Academy of Medical Sciences
| | - Yong Zhang
- Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University
| | - Lei Kong
- Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University
| | - Wei Qu
- Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University
| | - Jia Li
- Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University
| | - Yong-Sheng Gao
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University
| | - Yong-Hua Yu
- Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University
- Correspondence: Yong-Hua Yu, Department of Radiation Oncology Ward 2, Shandong Cancer Hospital Affiliated to Shandong University, 440 JiYan Road, Jinan, Shandong 250117, China (e-mail: )
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Kobayashi K, Sasaki K, Iijima T, Yoshimi F, Nagai H. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report. Int J Surg Case Rep 2016; 22:90-3. [PMID: 27064744 PMCID: PMC4832082 DOI: 10.1016/j.ijscr.2016.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex. PRESENTATION OF CASE A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively. DISCUSSION AND CONCLUSION Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures.
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Affiliation(s)
- Kosuke Kobayashi
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.
| | - Kazuhito Sasaki
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Tatsuo Iijima
- Department of Diagnostic Pathology, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Fuyo Yoshimi
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Hideo Nagai
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
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Chahal D, Martens M, Kinahan J. Mucinous cystic tumour of low malignant potential presenting in a patient with prior non-seminatous germ cell tumour. Can Urol Assoc J 2015; 9:E750-3. [PMID: 26664515 DOI: 10.5489/cuaj.2946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urachal neoplasms are rare entities which may be classified as cystic or non-cystic. Literature surrounding patient outcomes remains limited to non-cystic, urachal adenocarcinomas. Literature focusing on mucinous cystic neoplasms of the urachus is sparse. These mucinous cystic lesions may be subclassified as benign mucinous cystadenomas, mucinous cystic tumours of low malignant potential, and mucinous cystadenocarcinomas. Mucinous subtypes have the potential to behave aggressively and may result in pseudomyxoma peritonei. We describe here the case of a 37-year-old male with a mucinous cystic tumour of low malignant potential after prior right orchiectomy and left hydrocelectomy. This case raises the interesting possibility of multiple genitourinary neoplasms arising in a similar time frame.
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Affiliation(s)
- Daljeet Chahal
- Department of Pathology, University of British Columbia, Vancouver, BC
| | - Mildred Martens
- Royal Jubilee Hospital, Department of Pathology, University of British Columbia, Vancouver, BC
| | - John Kinahan
- Department of Urology, Royal Jubilee Hospital, Vancouver, BC
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9
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Gupta S, Bhaijee F, Harmon EP. Mucinous neoplasm arising in a urachal cyst: a first in the pediatric population. Urology 2013; 83:455-6. [PMID: 24231219 DOI: 10.1016/j.urology.2013.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/18/2013] [Accepted: 09/27/2013] [Indexed: 11/18/2022]
Abstract
Urachal anomalies are relatively uncommon and result because of incomplete obliteration of the urachus prenatally. In children, urachal cysts and sinuses constitute the common presentations, and these can sometimes become secondarily infected. Malignant involvement of the urachus in the pediatric population is rare, and primary urachal adenocarcinoma is reported exclusively in adults. Herein, we present the case of an adolescent girl with a low-grade mucinous neoplasm arising in a urachal cyst and discuss its significance.
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Affiliation(s)
- Shubham Gupta
- Division of Pediatric Urology, Department of Surgery, University of Mississippi, Jackson, MS
| | - Feriyl Bhaijee
- Division of Pediatric Urology, Department of Surgery, University of Mississippi, Jackson, MS
| | - Edwin P Harmon
- Division of Pediatric Urology, Department of Surgery, University of Mississippi, Jackson, MS.
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11
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Zong L, Chen P. Surgical and chemotherapeutic experience regarding a urachal carcinoma with repeated relapse: case report and literature review. World J Surg Oncol 2013; 11:170. [PMID: 23914849 PMCID: PMC3765469 DOI: 10.1186/1477-7819-11-170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 07/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background Urachal carcinoma is a rare tumor that is usually associated with a poor prognosis, especially the pathological type, urachal mucinous adenocarcinoma. Surgery remains the primary treatment in prolonging the overall survival time of patients. Case presentation We report on a 41-year-old woman with urachal mucinous adenocarcinoma who underwent three surgeries and several courses of chemotherapy over a 42-month period. The first surgery, involving en-bloc excision of the urachal mass, partial urinary bladder, urachal ligament, and umbilicus was performed in May 2007. It is well known that the correct surgical scheme plays a key role in preventing recurrence or metastasis. However, a second debulking surgery with only a single salpingo-oophorectomy may have contributed directly to the patient’s subsequent left ovarian metastasis. Therefore, we strongly recommend performing a bilateral salpingo-oophorectomy once ovarian metastasis has been detected, even if the metastasis is only present on one side. Although postoperative adjuvant chemotherapy regimens, first with Taxol, carboplatin, gemcitabine, and cisplatin, and then with IFO, EPI, and mesna were consecutively administered after the first and second surgeries, they seemed less effective, since recurrence and metastasis occurred shortly after each surgical treatment. After a third debulking surgery in June 2009, docetaxel, oxaliplatin, and capecitabine were administered. This chemotherapy regimen was chosen based on an immunohistochemical test that involved the multidrug resistance gene; this test indicated that the urachal mucinous adenocarcinoma was resistant to the two chemotherapy regimens used previously. Surprisingly, the patient exhibited a marker response to the new regimen and the metastatic foci entered into a stable disease stage. However, the patient still died of diffuse metastatic disease 1.5 years later. During the whole period of treatment, we found that serum tumor markers including CA724, CA125, CA19-9, and CEA were elevated in a linear pattern, with parallel increases in line with peritoneal carcinomatosis and parallel reductions in line with response to personalized chemotherapy. Conclusion Personalized treatment can be given to those patients who experience a poor response to initial therapy. Moreover, an immunohistochemical test for the multidrug resistance gene and serum tumor markers may supply key information in the choice of reasonable chemotherapeutics.
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12
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Schell AJ, Nickel CJ, Isotalo PA. Complex mucinous cystadenoma of undetermined malignant potential of the urachus. Can Urol Assoc J 2013; 3:E39-E41. [PMID: 19672436 DOI: 10.5489/cuaj.1139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urachal mucinous neoplasms are rare and include both villous adenomas and invasive adenocarcinomas. These mucinous tumours should be completely excised as they can demonstrate aggressive clinical behaviour, including the development of pseudomyxoma peritonei. We describe a 70-year-old woman who presented with a lower abdominal mass and received a diagnosis of a rare, complex urachal mucinous cystadenoma of undetermined malignant potential. This tumour demonstrated extensive mucin extravasation into perivesical soft tissue, but was not associated with pseudomyxoma peritonei or any malignancy. Rarely described in the English literature, mucinous cystadenomas of the urachus should be treated similarly to their villous adenoma counterparts: with complete surgical excision to prevent local tumour recurrences.
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Choi JW, Lee JH, Kim YS. Urachal mucinous tumor of uncertain malignant potential: a case report. KOREAN JOURNAL OF PATHOLOGY 2012; 46:83-6. [PMID: 23109984 PMCID: PMC3479701 DOI: 10.4132/koreanjpathol.2012.46.1.83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/11/2011] [Accepted: 02/22/2011] [Indexed: 11/17/2022]
Abstract
Urachal mucinous tumor of uncertain malignant potential is very rare and is characterized by a multilocular cyst showing the proliferation of atypical mucin-secreting cells without stromal invasion. As in ovarian and appendiceal borderline tumors, it represents a transitional stage of mucinous carcinogenesis in the urachus. In addition, this tumor may recur locally and develop into pseudomyxoma peritonei. Due to its scarcity and diagnostic challenges, we report a mucinous tumor of uncertain malignant potential arising in the urachus.
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Affiliation(s)
- Jung-Woo Choi
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Araki M, Saika T, Araki D, Kobayashi Y, Uehara S, Watanabe T, Yamada K, Nasu Y, Kumon H. Laparoscopic management of complicated urachal remnants in adults. World J Urol 2012; 30:647-50. [DOI: 10.1007/s00345-012-0829-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/13/2012] [Indexed: 11/27/2022] Open
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Shanks JH, Iczkowski KA. Divergent differentiation in urothelial carcinoma and other bladder cancer subtypes with selected mimics. Histopathology 2008; 54:885-900. [PMID: 19178589 DOI: 10.1111/j.1365-2559.2008.03167.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Conventional urothelial carcinoma accounts for most carcinomas of the urinary tract lining. However, neoplastic urothelium has the capacity to demonstrate enormous plasticity. A variety of unusual architectural patterns of urothelial carcinoma, such as the nested, microcystic and inverted variants, can be mistaken for reactive processes or benign tumours. Others such as the micropapillary, plasmacytoid and discohesive variants, can mimic metastatic tumour from other sites. The micropapillary variant in particular is more aggressive. In addition, urothelial carcinoma has a propensity to demonstrate divergent differentiation with glandular, squamous, small cell neuroendocrine, lymphoepithelioma-like, sarcomatoid or other elements. Pure squamous carcinoma or adenocarcinoma (the latter in particular) can be difficult to distinguish from contiguous or metastatic spread. Some variants have prognostic and potential therapeutic implications. Molecular genetic evidence has emerged recently supporting a close relationship between urothelial carcinoma and various divergent elements. Sarcomatoid carcinoma and its differential diagnosis with other spindle cell lesions of urinary tract will be covered in a separate review.
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Affiliation(s)
- J H Shanks
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, UK.
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Cruz-Gonzáles G, Sánchez-Salas R, Palmer-Román K, Sánchez-Rivero F, Sanchez-Salas R, Daboin I, Mota D, León A. [Primary signet ring cell bladder adenocarcinoma. Case report with a multidisciplinary therapeutical approach]. Actas Urol Esp 2007; 31:919-22. [PMID: 18020218 DOI: 10.1016/s0210-4806(07)73748-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Bladder carcinoma is the second most frequent genitourinary tumor. Adenocarcinoma accounts for up to 0.5 to 2% of bladder carcinoma types. The pathology states the bladder adenocarcinomas are mucous secreting lesions with glandular, colloid or signet ring cell patterns. Even the important advances reached in the field of bladder carcinoma, yet less frequent lesions as bladder adenocarcinoma do not have a standarized treatment protocol. METHODS Case report of a patient with primary signet ring cell bladder adenocarcinoma with a therapeutical multidisciplinary approach. Literature review. RESULTS Patient's outcome and follow up, with regard of therapeutical implications based on pathological findings. CONCLUSIONS Bladder adenocarcionoma is a rare oncological entity. Treatment protocols for these particular tumors are lacking. Multidisciplinary approach represents the best therapeutical intervention.
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Shinohara T, Misawa K, Sano H, Okawa Y, Takada A. Pseudomyxoma peritonei due to mucinous cystadenocarcinoma in situ of the urachus presenting as an inguinal hernia. Int J Clin Oncol 2007; 11:416-9. [PMID: 17058142 DOI: 10.1007/s10147-006-0594-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 06/05/2006] [Indexed: 10/24/2022]
Abstract
Pseudomyxoma peritonei is generally caused by appendiceal and ovarian tumors. Other primary sites have been rarely reported. We describe herein the second reported case of pseudomyxoma peritonei due to mucinous cystadenocarcinoma of the urachus. A 54-year-old man was admitted with a left inguinal hernia that had developed several months prior to his admission. During herniorrhaphy, we found a large amount of gelatinous mucinous material in the indirect-hernia sac and made a diagnosis of pseudomyxoma peritonei on cytological grounds. At re-operation, the origin of the pseudomyxoma peritonei proved to be a ruptured urachal cyst. The urachal cyst and the dome of the urinary bladder were excised. In addition, we removed as much of the gelatinous material as possible. On histological examination, a unilocular cyst was found to consist of noninvasive mucinous adenocarcinoma. We succeeded in removing the rest of the mucinous material by postoperative intraperitoneal lavage with dextran solution, and have observed no evidence of recurrence for 7 years since the operation.
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Affiliation(s)
- Toshiki Shinohara
- Department of Surgery, Sapporo City General Hospital, Sapporo, Japan.
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18
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Ashley RA, Inman BA, Sebo TJ, Leibovich BC, Blute ML, Kwon ED, Zincke H. Urachal carcinoma: clinicopathologic features and long-term outcomes of an aggressive malignancy. Cancer 2006; 107:712-20. [PMID: 16826585 DOI: 10.1002/cncr.22060] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Richard A Ashley
- Department of Urology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Mazzucchelli R, Scarpelli M, Montironi R. Mucinous adenocarcinoma with superficial stromal invasion and villous adenoma of urachal remnants: a case report. J Clin Pathol 2003; 56:465-7. [PMID: 12783975 PMCID: PMC1769974 DOI: 10.1136/jcp.56.6.465] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This report describes a case of mucinous adenocarcinoma with superficial stromal invasion and villous adenoma originating in the dome of the urinary bladder. Although no urachal remnants were identified, the location suggested urachal derivation. Only two previous cases of urachal adenocarcinoma with features of early stromal invasion associated with a villous tumour have been described.
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Affiliation(s)
- R Mazzucchelli
- Institute of Pathological Anatomy and Histopathology, Ancona University School of Medicine, 60020 Torrette, Ancona, Italy
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20
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Palmero Martí JL, Queipo Zaragozá JA, Bonillo García MA, Budía Alba A, Vera Sempere FJ, Jiménez Cruz JF. [Mucinous adenocarcinoma of the bladder]. Actas Urol Esp 2003; 27:274-80. [PMID: 12830548 DOI: 10.1016/s0210-4806(03)72920-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mucinous adenocarcinoma is a rare entity within the group of primary adenocarcinoma of the bladder which represent 0.5-2% of all malignant epithelial bladder tumours. In spite of the rarity of this tumoral type; it is a poor prognosis entity mainly due to its diagnosis especially in advanced stage of the disease. There is no general agreement on the treatment of adenocarcinoma of bladder. Not withstanding surgery would be the only curative treatment, although unfortunately, it is curative in just a few cases. We report six cases with mucinous adenocarcinoma of the bladder attended in our Department in the last ten years (january 1991-december 2001). In one of them a radical cystectomy was performed, while transurethral resection with or without adjuvant treatment was practiced in the other one. Only one patient is alive today, namely, the one where the tumour not invade the muscular tissue. These findings show the discouraging results of this entity closely intertwined with the pathologic stage.
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Stenhouse G, McRae D, Pollock AM. Urachal adenocarcinoma in situ with pseudomyxoma peritonei: a case report. J Clin Pathol 2003; 56:152-3. [PMID: 12560399 PMCID: PMC1769875 DOI: 10.1136/jcp.56.2.152] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 54 year old man presented with a six month history of abdominal pain. A computerised tomography scan showed a well defined intra-abdominal unilocular mass with a calcified wall just superior to the bladder. At laparotomy, pseudomyxoma peritonei was discovered, together with a midline abdominal mass adherent to the anterior abdominal wall originating from the fundus of the bladder. The specimen consisted of a cystic mass measuring 14 x 9.5 x 7 cm overall, which contained mucoid material. Histological examination revealed that the cyst was lined by mucinous epithelium, which in areas varied from having bland morphology to showing pronounced nuclear and architectural atypia. There was abundant extracellular mucin. The specimen was extensively sampled but there was no evidence of invasion. This tumour has many unusual features, namely: the absence of destructive invasion, association with pseudomyxoma peritonei, areas of dysplasia and cystadenoma, and stromal osseous metaplasia within the wall.
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Affiliation(s)
- G Stenhouse
- Department of Pathology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZD, UK.
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Affiliation(s)
- F J Mangiacapra
- Department of Radiology, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA.
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