Sandoval-Téllez JG, Ricardez-Espinosa AA, Suárez-Uriarte MJ, Reyes-De la Garza I, Jiménez-López LÁ

Language: Spanish
References: 11
Page: 215-219
PDF size: 455.81 Kb.

ABSTRACT

Background: Tumors of the urachus make up less than 1% of the bladder neoplasia and approximately 20 to 35% of bladder adenocarcinomas. At present, little is known of the pathology. Etiology and pathogenesis are still uncertain and risk factors for those tumors have not been identified.
Clinical case: A 41-year-old man came to the urology service due to gross hematuria with no clot formation, accompanied by pain in the hypogastrium. Physical examination revealed an abdomen with a slightly increased volume in the hypogastrium. A mobile, nonpainful, mildly indurated tumor dependent on the umbilicus, measuring approximately 5 cm and not fixed to the deep planes was palpated. Abdominopelvic tomography identified a urinary bladder with wall thickening and a heterogeneous, irregular image measuring 38 x 27 mm at the midline, with punctiform peripheral calcifications. Cystoscopy showed a solid tumor in the bladder dome with a diameter of 3 cm, brown areas, and irregular edges. Treatment was partial cystectomy and in bloc resection of the urachus, in addition to lymphadenectomy and omentectomy.
Conclusions: Carcinoma of the urachus is a rare alteration and most information on it comes from case reports and case series. The treatment of choice is partial cystectomy and en bloc resection of the urachus, which has provided good results and progressionfree survival rates from 40 to 60%, depending on the type of procedure performed.

REFERENCES

1. Begg RC. The urachus: Its anatomy, histology and development. J Anat. 1930;64:170-83.

2. Szarvas T, Módos O, Niedworok C, Reis H, et al. Clinical, prognostic, and therapeutic aspects of urachal carcinoma-A comprehensive review with meta-analysis of 1,010 cases. Urol Oncol 2016;34(9):388-398.

3. Cruz P, Ramírez M, Iborra I, Rubio J, et al. Adenocarcinoma de uraco: ¿qué tanto sabemos? Rev Mex Urol 2014;74(5):301-307.

4. Sheldon CA, Clayman RV, González R, Williams R, Fraley EF. Malignant urachal lesions. J Urol 1984;131:1-8.

5. Herr HW, Bochner BH, Sharp D, Dalbagni G, Reuter VE. Urachal carcinoma: contemporary surgical outcomes. J Urol 2007;178:74-78.

6. Molina JR, Quevedo JF, Furth AF, Richardson RL, et al. Predictors of survival from urachal cancer. A Mayo Clinic study of 49 cases. Cancer 2007;110:2434-40.

7. Ashley RA, Inman BA, Sebo TJ, et al. Urachal carcinoma: Clinicopathologic features and long term outcomes of an aggressive malignancy. Cancer 2006;107:712-20.

8. Thali-Schwab CM, Woodward PJ, Wagner BJ. Computed tomographic appearance of urachal adenocarcinomas: Review of 25 cases. Eur Radiol 2005;15:79.

9. Siefker-Radtke AO, Gee J, Shen Y, et al. Multimodality management of urachal carcinoma: The M.D. Anderson experience. J Urol 2003;169:1295-8.

10. Paner GP, McKenney JK, Barkan GA, et al. Immunohistochemical analysis in a morphologic spectrum of urachal epithelial neoplasms: Diagnostic implications and pitfalls. Am J Surg Pathol 2011;35:787-98.

11. Meeks JJ, Herr HW, Bernstein M, et al. Preoperative accuracy of diagnostic evaluation of the urachal mass. J Urol 2013;189:1260-2.