A case of urachal xanthogranuloma causing recurrent intestinal obstruction

A 68-year-old male was admitted to our hospital with the chief complaints of lower abdominal pain and fever. There was a tender mass palpable in the lower abdomen. Plain abdominal X-ray film revealed multiple air-fluid levels with dilated small bowel loops, suggesting intestinal obstruction. Abdominal ultrasonography, computed tomography and magnetic resonance imaging revealed a solid mass extending from umbilicus to the bladder dome beneath the rectal muscle. There was normal mucosa of the bladder by cystoscopic examination. A urachal tumor was clinically suspected and en bloc removal of the mass, the remaining urachus, umbilicus, omentum and bladder dome was performed. The histological diagnosis was urachal xanthogranuloma. The patient has remained in good health without any recurrence for 6 months since the surgery. We discuss urachal xanthogranuloma in the literature.     

Desmoid tumor of the abdominal wall preoperatively suspected as urachal tumor: a case report]

A case of desmoid tumor of the abdominal wall which was preoperatively suspected as urachal tumor is presented. The patient was a 56-year-old man, who was referred to our clinic for further examination of the mass detected incidentally in the ventral region of the urinary bladder by computed tomography. Ultrasonography showed that the mass had a heterogenous and hypoechogenic content. An urachal tumor was suspected and surgery was performed to remove the tumor. During the operation we found that the tumor was completely separated from the urinary bladder and that it had originated from the left rectus abdominal muscle. The pathological diagnosis was desmoid tumor of the abdominal wall. Since urachal tumor has no characteristic findings on the imaging examinations, it is difficult to differentiate desmoid tumor of the lower abdominal wall from urachal tumor, preoperatively.     

A case of abdominal desmoid tumor that was difficult to differentiate from urachal tumor

A 76-year-old male patient complained of frequent urination. Computed tomographic and magnetic resonance imaging scans revealed a heterogeneous mass involving his bladder, prostate and Sigmoid colon. He was diagnosed with an invasive urachal tumor and surgery was performed due to severe tumor adhesion to adjacent organs. Partial resection of the tumor was performed with partial cystectomy and sigmoidectomy. A post-operative pathological diagnosis revealed the tumor was a desmoid abdominal wall tumor. The desmoid abdominal wall tumor was not easily differentiated preoperatively from an urachal tumor.     

A case of urachal abscess mimicking a tumor in the retrovesical space

A 14-year-old girl was admitted to our hospital because of umbilical erythema and discharge. She had had an appendectomy at the age of twelve. Abdominal ultrasonography and cystoscopy revealed a large tumor-like mass at the posterior wall of the bladder. Computed tomography and magnetic resonance imaging revealed urachal sinus. The diagnosis of urachal abscess had been confirmed and conservative treatment had been continued by drainage via umbilicus and the administration of antibiotics. Total excision of the urachus was performed about one month later because the bladder mass was not reduced. Pathological findings revealed an inflammatory thickened wall of the urachus and no evidence of malignancy. We report this rare case of urachal abscess with a large mass in the retrovesical space.     

A case of urachal abscess

A 26-year-old male with urachal abscess was demonstrated. Ultrasonography, CT and MRI revealed that there was a mass at the supravesical region, which was connected to the umbilicus. However, a differential diagnosis as to whether the mass was a tumor or an abscess was difficult from these examinations. Thus we performed an open biopsy. A pathological examination revealed no malignant change in the biopsy specimen. On the other hand, the pathological diagnosis of a follicular tumor located at the roof of the urinary bladder was TCC G2, but we considered that, this change was a reactive hyperplasia with dysplasia resulting from chronic inflammation of urachal abscess. Thus, the complete excision of urachal abscess and partial cystectomy were performed. The serial sections of the bladder wall revealed no malignant changes. We reviewed similar cases reported in our country and discussed various factors causing urachal abscess, especially related to the infectious root.     

A case of infected urachal cyst--a review of Japanese case reports of urachal cyst

A 24-year-old female with infected urachal cyst is reported. She was admitted to the hospital with complaints of a lower abdominal mass, abdominal pain and cystitis symptom. Brownish pus discharges from her umbilicus were recognized by manual compression of the lower abdominal mass. Cystoscopy revealed a small orifice at the dome of the bladder, and pus discharges from this orifice. A pooling of contrast medium (8 X 2.5 cm) under the umbilicus was detected by a fistelography from the umbilicus, and a low density mass was detected under the abdominal wall between the umbilicus and the dome of bladder on a CT scan. So she was diagnosed as an infected urachal cyst and operated on. The urachal cyst which was adhered to the peritoneum had penetrated both the umbilicus and bladder at the time of operation. Complete removal of the urachal cyst with partial cystectomy was done. We also reviewed the Japanese case reports of urachal cyst.     

A case of serous papillary adenocarcinoma of the ovary initially suspected to be a uretero-vaginal fistula

A case of serous papillary adenocarcinoma of the ovary initially suspected to be an uretero-vaginal fistula is reported. The patient was a 57-year-old female with the complaint of urinary leakage from the vagina. Because she had undergone a supravaginal hysterectomy for myoma uteri 10 years earlier, a uretero-vaginal fistula was initially suspected. However, the fistula was not recognized from the findings of excretory and retrograde pyelographies. Chemical analysis of the vaginal discharge was similar to serum rather than urine. Gynecological examination showed the presence of an ovarian tumor. Right oophorectomy and extirpation of remaining cervix combined with partial resection of rectum was performed. From the pathological finding that the tumor consisted of serous papillary adenocarcinoma, the vaginal discharge was confirmed to originate from the tumor. Ovarian tumors with serous discharge from the vagina seem to be very rare.     

A case of pedunculated hepatoma suspected of adrenal tumor

We herein report a case of pedunculated hepatoma which was preoperatively diagnosed as nonfunctioning adrenal tumor. A 51-year-old man was admitted for further examination of right hypochondrial pain. CT scan showed a right suprarenal mass. Tumor vessels were visualized on selective right renal arteriography and right inferior phrenic arteriography. Adrenal function was normal. Preoperative diagnosis was nonfunctioning right adrenal tumor. On operation, we found a right suprarenal tumor which was in continuity with the inferior part of the liver. Pathological diagnosis of the biopsy specimen was hepatocellular carcinoma (Edmondson's grade 3). Difficulty of preoperative diagnosis of pedunculated hepatoma is discussed.     

Multiple intracerebral enhanced lesions strongly suspected to be microsporidiosis. A case report

This case of microsporidiosis manifested as mutiple intracranial lesions separated in space and time, and neurological and radiological findings were improved with albendazole administration. A 33-year-old man presented with headache, fever, and dysphasia. His consciousness was clear. Neurological examination revealed acalculia, agraphia, and homonymous hemianopsia. He had a past history of febrile convulsive seizures of unknown cause until 14-years-old, but no history of immunodeficiency. T1-weighted magnetic resonance (MR) imaging showed a hypointense lesion with a hyperintense part, and ring-like enhancement with gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA), in the left temporal lobe. T2-weighted and diffusion-weighted MR imaging showed the lesion surrounded by moderate hyperintense areas. He underwent gross total resection of the lesion. Histological examination demonstrated intracellular clusters of small basophilic spore-like bodies in the astrocytes, suggestive of microsporidia-infected astrocytes. However, immunohistochemical, polymerase chain reaction, and serological analyses failed to confirm the definitive diagnosis of microsporidiosis, so that he received no further treatment. Three years later, he presented with sensory disturbance in the left side of his face and left cerebellar ataxia, followed by fever, abnormal sensation in the left side of his face, and aggravated ataxia of the left upper and lower extremities on day 10 after admission. T1-weighted MR imaging with Gd-DTPA showed an enhanced lesion with irregular margin in the left cerebellar peduncle. T2-weighted MR imaging showed a diffuse hyperintense region around the lesion. Cerebrospinal fluid culture, serological analysis for autoimmune disease, and thoracic, abdominal, and pelvic computed tomography and 18F-fluorodeoxyglucose-positron emission tomography detected no abnormalities such as cancers or other lesions in the extracranial organs. No definitive diagnosis was obtained, but recurrence of microsporidiosis was the most probable cause. Administration of albendazole (600 mg/day) was started on day 15, because of rapid neurological and radiological deterioration. This treatment resulted in clinical improvement and disappearance of the lesion on MR imaging after daily administration for 4 weeks. He was discharged on foot with moderate sensory disturbance in the left side of the face and ataxia. Based on the clinical course and negative findings, the final diagnosis was microsporidiosis. This case suggests that microsporidiosis in the central nervous system can persist even in immunocompetent patients without involvement of any other organs, and that albendazole administration is likely to be effective.     

A case of pedunculated hepatoma suspected of adrenal tumor]

A case of pedunculated hepatoma which was preoperatively diagnosed as non-functioning adrenal tumor is reported. A 48-year-old man presented to our hospital for further examination of remittent fever and leg edema. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging showed a right suprarenal mass, its continuity of liver was uncertain. Tumor vessels were visualized on selective right adrenal arteriography and right adrenal function and serum alpha-fetoprotein were normal. Preoperative diagnosis was non-functioning right adrenal tumor. On operation, the dissection between the tumor and the inferior part of liver was easy. Pathological diagnosis was hepatocellular carcinoma with sarcomatous change. Difficulty of preoperative diagnosis of pedunculated hepatoma is discussed.     

Metastatic brain tumor originating from urachal carcinoma: case report

The authors presented a patient with metastatic brain tumor originating from urachal carcinoma. A 64-year-old female was admitted to our hospital with complaints of memory disturbance, indifference and apathy of 3 months duration. Head CT and MRI on admission showed a round mass with perifocal edema in the right frontal lobe. After administration of Gd-DTPA, the mass lesion showed ringed enhancement effect. Pelvic MRI scan revealed a bladder tumor, which was diagnosed as urachal carcinoma. The brain lesion was suspected to have metasta sized metastatic from urachal carcinoma, and was excised by craniotomy. Histology of the brain tumor was identical to that of urachal carcinoma. Postoperatively the patient received local radiation therapy, but died of multiple metastasis to lung and local recurrence, 18 months later. Urachal carcinoma is an extremely rare tumor, comprising 0.17-0.34% of all bladder tumors. Though this rare tumor carries a poor prognosis, it may be effective for longer survival of a patient to treat the metastatic brain lesion with surgery and radiation.     

Retroperitoneal fibrosis suspected to be ureteral tumor because of its localization at the unilateral distal ureter: a case report]

The patient was a 32-year-old female with the complaint of right flank pain. Drip infusion pyelogram showed right hydronephrosis and retrograde urogram demonstrated a marked stenosis about 2 cm in length at the right distal ureter. The passage of the ureteral catheter and the contrast medium through the narrowing portion of the ureter could not be performed. The abdominal computerized tomographic (CT)-scan disclosed renal subcapsular urinoma, although no abnormal findings which caused ureteral stenosis were revealed. A suspicion of right ureteral tumor was entertained and total nephroureterectomy was performed. Histopathological diagnosis was the idiopathic retroperitoneal fibrosis, which involved the right ureter. One hundred and fifty five cases of idiopathic retroperitoneal fibrosis in the Japanese literature were reviewed.     

A case of exohepatic pedunculated hepatocellular carcinoma suspected of adrenal tumor

A case of exohepatic pedunculated hepatocellular carcinoma that was clinically diagnosed as nonfunctioning adrenal tumor is reported. A 66-year-old man was admitted to our hospital for further examination of unstable angina pectoris. Abdominal echogram and CT scan revealed a large tumor in the right retroperitoneal space. Selective right renal arteriography demonstrated that the tumor was fed by the capsular branch of right renal artery and the right adrenal artery. Adrenal function was normal. Preoperative diagnosis of right nonfunctioning adrenal tumor was made. On operation we found that the tumor was pedunculated from the liver and adhered massively to both right kidney and vena cava. The tumor and right kidney were removed. A histopathological examination demonstrated well differentiated hepatocellular carcinoma (Edmondson's grade II type).     

Primary urachal adenocarcinoma: A case report

Primary urachal adenocarcinoma is an aggressive rare cancer that often presents at advanced stages with poor prognosis. We report this case of a 52-year-old patient with a stage-I (Mayo Clinic) primary urachal adenocarcinoma with good outcomes after surgery in a 2-year follow-up period. We analyze epidemiological, clinical and therapeutic features of this disease in the literature review.     

Coronary artery bypass graft stenosis suspected to be due to hemostatic agents: a case report

A 66-year-old man had a CABG with a saphenous vein graft. During the surgery, oxidized cellulose and fibrin glue were used and left in place for hemostasis. Six months after the surgery, the first postoperative CAG was performed and a stenosis of the coronary bypass graft near the proximal anastomosis was found. The first PTCA was done and the stenosis was released. Re-stenosis was observed at the same site one year after the first PTCA and a second one was performed. Five years and nine months after the surgery, the patient started complaining of severe chest pain even though he was receiving medication. Graft stenosis at the same site was observed by CAG. A cyst 3 cm in diameter, with irregular wall thickness was found near the proximal portion of the bypass graft. Resection of the cyst and re-CABG was performed uneventfully. Microscopically, the cyst consisted of fibroblasts, small vessels, collagen fiber and giant cells and was diagnosed as granuloma. In the giant cells, oxidized cellulose fiber was observed. No comparable cases have been reported in the literature. Topical hemostatic agents were discussed.     

A fatal case of ruptured infected urachal cyst

A case of a 12 years old school girl is described. She presented nine days after the onset of acute periumbilical abdominal pain which was later accompanied three days prior to admission by purulent discharge from the umbilicus. Radiological investigation revealed a pelvic collection of pus with retroperitoneal extensions. Late presentation made the attempt to save the patient unsuccessful. A review of the literature reveals that extensive intraperitoneal and retroperitoneal extension of abscess resulting from anomaly of the urachus is extremely rare.