A case of an abdominal wall cystic urachal carcinoma in an unusual location

Abstract

A solitary cystic lesion in the abdominal wall is generally benign, such as an omental cyst, mesenteric cyst, enteric duplication cyst, cystic mesothelioma, or skin appendage tumor. Furthermore, most malignancies in the urachal remnant are intraperitoneal lesions, and generally develop on the anterior aspect of the bladder dome. Moreover, most urachal glandular malignant neoplasms are the mucinous cystic type. We report a cystic urachal adenocarcinoma that presented as an abdominal wall cystic lesion. A 42-year-old woman was admitted to Kangwon National University Hospital for a 5-cm palpable abdominal wall mass. Conservative surgical excision was performed with subsequent histological and immunohistochemical evaluations, but only a few non-mucinous invasive glands and finger-like growths were noted. During a 2-year period, the tumor recurred several times along the urachal tract and metastasized to the regional lymph nodes. Despite receiving chemotherapy, the patient died 2 years after the first surgery.

Keywords

Adenocarcinoma / Abdominal wall / Urachal cyst

FUNDING

This report was supported by a Research Grant from Kang-won National University (C1010345-01-01).

CONFLICTS OF INTEREST DISCLOSURE

The authors declare that they have no potential conflicts of interest with respect to the research, authorship, and/or publications of this article.

References

[1] Schubert GE, Pavkovic MB, Bethke-Bedürftig BA. Tubular urachal remnants in adult bladders. J Urol. 1982; 127: 40-42. https://doi.org/10.1016/S0022-5347(17)53595-8

[2] Paner GP, Barkan GA, Mehta V, et al. Urachal carcinomas of the nonglandular type: salient features and considerations in pathologic diagnosis. Am J Surg Pathol. 2012; 36: 432-442. PMid: 22301493. https://doi.org/10.1097/PAS.0b013e31823fe49c

[3] Siefker-Radtke A. Urachal carcinoma: surgical and chemotherapeutic options. Expert Rev Anticancer Ther. 2006; 6: 1715-1721. PMid: 17181485. https://doi.org/10.1586/14737140.6.12.1715

[4] Gopalan A, Sharp DS, Fine SW, et al. Urachal carcinoma: a clinicopathologic analysis of 24 cases with outcome correlation. Am J Surg Pathol. 2009; 33: 659-668. PMid: 19252435. https://doi.org/10.1097/PAS.0b013e31819aa4ae

[5] Amin MB, Smith SC, Eble JN, et al. Glandular neoplasms of the urachus:a report of 55 cases emphasizing mucinous cystic tumors with proposed classification. Am J Surg Pathol. 2014; 38: 1033-1045. https://doi.org/10.1097/PAS.0000000000000250

[6] 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: 787-798. PMid: 21572312. https://doi.org/10.1097/PAS.0b 013e3182189c11

[7] Ashley RA, Inman BA, Sebo TJ, et al. Urachal carcinoma: clinicopathologic features and long-term outcomes of an aggressive malignancy. Cancer. 2006; 107: 712-720. PMid: 16826585. https://doi.org/10.1002/cncr.22060

[8] Henly DR, Farrow GM, Zincke H. Urachal cancer: role of conservative surgery. Urology. 1993; 42: 635-639. https://doi.org/10.1016/0090-4295(93)90526-G

[9] Yasui T, Okamura T, Akita H, et al. Urethral recurrence of an urachal carcinoma: a case report. Int J Urol. 1997; 4: 106-108. PMid:9179681. https://doi.org/10.1111/j.1442-2042.1997.tb00154.x

[10] Paul AB, Hunt CR, Harney JM, et al. Stage 0 mucinous adenocarcinoma in situ of the urachus. J Clin Pathol. 1998; 51: 483-484. PMid: 9771454. https://doi.org/10.1136/jcp.51.6.483

[11] Kato H, Hayama M, Kobayashi M, et al. Large intestinal typeurachal adenocarcinoma with focal expression of prostatic specific antigen. Int J Urol. 2004; 11: 1033-1035. PMid: 15509213. https://doi.org/10.1111/j.1442-2042.2004.00940.x

[12] Pal DK, Chowdhury MK. Urachal adenocarcinoma masquerading as an urachal cyst. Indian J Surg. 2008; 70: 135-137. PMid: 23133041. https://doi.org/10.1007/s12262-008-0037-5

[13] Scabini S, Rimini E, Romairone E, et al. Urachal tumour: case report of a poorly understood carcinoma. World J Surg Oncol. 2009; 7: 82. PMid:19895702. https://doi.org/10.1186/1477-7819-7-82

[14] Lamb BW, Vaidyanathan R, Laniado M, et al. Mucinous adenocarcinoma of the urachal remnant with pseudomyxoma peritonei. Urol J. 2010; 7: 138-139. PMid: 20535705.

[15] Fanning DM, Sabah M, Conlon PJ, et al. An unusual case of cancer of the urachal remnant following repair of bladder exstrophy. Ir J Med Sci. 2011; 180: 913-915. PMid: 19294480. https://doi.org/10.1007/s11845-009-0310-z

[16] Bissonnette ML, Kocherginsky M, Tretiakova M, et al. The different morphologies of urachal adenocarcinoma do not discriminate genomically by micro-RNA expression profiling. Hum Pathol. 2013; 44: 1605-1611. PMid: 23528864. https://doi.org/10.1016/j.humpath.2013.01.008