Carcinoma of urachus: report of 3 cases and review of literature

Three cases of urachal carcinoma are presented. Chief complaints were passage of mucous urine in a 58-year-old man (case 1), hematuria and frequency in a 63-year-old woman (case 2) and hematuria in a 45-year-old man (case 3). Urine cytology were negative for all cases and serum CEA level was elevated in case 1. Mass in the area of the bladder dome were revealed by cystoscopic examination in all cases. CT scanning, TUR biopsy and cystogram were valuable diagnostic procedure. En bloc segmental resection were performed on all cases, and case 1 and case 2 have been well without disease for 36 and 40 months, respectively. Case 3 died 65 months after operation with disseminated carcinoma. Histologically mucin-producing adenocarcinoma were found in all cases. Statistic examination and discussion are made of 237 cases of urachal carcinoma reported in Japan.     

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.     

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.     

Actinomycosis of urachal remnants

We report a case of urachal actinomycosis. The patient presented with complaints of micturition pain and a lower abdominal mass. Computerized tomography and an echogram showed the mass extending from the dome of the bladder to just beneath the rectus muscle. Exploration revealed a hard mass in the urachal cord, which was near the dome of the bladder and extended to the umbilicus. The mass and urachal cord were resected, and histopathological examination revealed actinomycosis of the urachal remnants.     

Squamous cell carcinoma of the urachus

A 64-year-old man was admitted with complaints of abdominal pain and pollakisuria. A soft mass was palpable under his navel. Magnetic resonance imaging (MRI) revealed a 9 x 6 cm tumor, which was composed of a cystic lesion arising from the urachus and a solid mass component at the urinary bladder dome. Urine cytology specimens showed squamous cell carcinoma (SCC). Serum SCC level was increased and the tumor was removed surgically. Histological examination detected well-differentiated SCC, which had invaded the urinary bladder and the peritoneum. The patient has been followed up without recurrence for 6 months.     

Carcinoma of the urachus--report of 4 cases

Four cases of urachal carcinoma are presented. The first case was a 36-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiation therapy were performed. Histological findings showed a well differentiated adenocarcinoma. He has been well for twelve years postoperatively. The second case was a 52-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiochemotherapy were performed. Histological findings showed a moderately differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The third case was 70-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed multiple tumors at the dome of the bladder, internal urethral orifice and right lateral wall. Total cystectomy, ureterocutaneostomy and postoperative chemotherapy were performed. Histological findings showed a poorly differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The fourth case was a 68-year-old woman who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. CT scan demonstrated a mass with calcification extending from the bladder dome superiorly. Partial cystectomy and postoperative chemotherapy were performed. Histological findings showed a well differentiated adenocarcinoma. She has been well for three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of urachal actinomycosis with bone formation

We report a case of urachal actinomycosis with bone formation. A 76-year-old woman was admitted to our hospital with a complaint of gross hematuria. Cystoscopy revealed bleeding from the dome of the bladder wall. Magnetic resonance imaging revealed a mass extending from the dome of the bladder to just below the umbilicus. A urachal tumor was clinically suspected, and the mass was resected together with urachal remnant and part of the bladder wall. Pathological diagnosis of the specimen was actinomycosis. The bone tissue was found in the abcess. Actinomycosis is a chronic suppurative infection caused by Actinomyces israelii. Although urachal actinomycosis is a rare desease, it is important to recognize this uncommon intrapelvic infection as the differential diagnosis of any intrapelvic mass.     

Synchronous and multiple transitional cell carcinoma of the bladder and urachal cyst

Abstract:   Incomplete involution of the allantoic duct can result in different pathological forms of urachus which can give rise to inflammation or late malignant changes. Among urachal tumors, adenocarcinoma is most frequent, although other histological types can also be found. The synchronous presentation of a urachal transitional cell tumor, along with recurrent superficial bladder tumors has not been reported previously. We are reporting a 49-year-old male patient in whom transitional cell carcinoma of a urachal cyst was found with recurrent, multiple bladder tumors. The diagnosis of urachal cyst tumor was established according to ultrasonography and computed tomography. Most of the bladder tumors were resected transurethrally while open surgical excision of the urachal cyst with en bloc resection of the bladder dome was performed. Recurrent bladder tumors were afterwards treated with Bacillus Calmette Guerin (BCG) instillations. A year after surgery the patient has no signs of local recurrence or distant metastases of transitional cell carcinoma.     

Abscess of urachal remnant mimicking urinary bladder neoplasm.

Three cases of urachal abscess with extensive interstitial inflammation and fibrosis are reported. Clinically, all patients had a lower abdominal mass and CT scan and ultrasonic examination revealed a large tumour located anterior or superior to the bladder. They all underwent laparotomy and had either a partial cystectomy or an en bloc resection of the bladder and adjacent organs due to severe adhesions. Microscopic examination of the specimens revealed no evidence of carcinoma and only abscess formation with extensive chronic interstitial inflammation and fibrosis were seen. In one case, residual columnar epithelium suggestive of urachal origin was identified in the abscess cavity. Urachal abscess should be considered when dealing with lower abdominal masses.     

Laparoscopic resection of an adenoma of the urachus in combination with a laparoscopic cholecystectomy

In a 40-year-old male patient with symptomatic cholecystolithiasis, ultrasound examination disclosed a large cystic mass on the dome of the bladder. Laparoscopic resection of this mass was carried out in combination with a laparoscopic cholecystectomy. Histology disclosed an urachal adenoma. Postoperative recovery was uneventful. We conclude that urachal adenomas can be managed safely by laparoscopic means.     

A case of urachal xanthogranuloma suspected to be a urachal tumor

A 47-year-old female consulted our hospital with the chief complaints of lower abdominal pain and fever. There was a palpable mass in the lower abdomen. The patient had undergone oophorectomy by lower abdominal median incision. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) demonstrated a cystic mass above the bladder dome extending to the umbilicus, which was strongly suspected to be a urachal tumor. Enhanced T1 weighted MRI showed a mass enhanced by contrast media. Partial cystectomy with urachal resection was performed by lower abdominal median incision. The histological diagnosis was xanthogranuloma. This is the thirteenth case report of xanthogranuloma of the urachus in the Japanese literature.     

Giant sarcomatoid carcinoma with spontaneous vesical rupture: a case report

A 60-year-old woman has been on steroids under the diagnosis of polymyositis for 25 years. She was referred to our hospital complaining of asymptomatic macroscopic hematuria and lower abdominal pain. Physical examination revealed abdominal tenderness and rigidity. We suspected peritonitis because of free air image on the abdominal roentogenogram. The computed tomographic (CT) scan demonstrated an 8 cm solid mass in the bladder and defect of anterior wall of urinary bladder. Then we performed total cystectomy with cutaneous ureterostomy and partial resection of ileum as an emergency operation. Macroscopically, intra-peritoneal bladder rupture and severe adhesion of necrotic bladder dome wall to ileum were recognized and the tumor 8 cm in diameter existed in posterior wall of urinary bladder. Microscopic examination showed sarcomatoid carcinoma with spindle cell component and no invasion to ileum was recognized. Multiple lung, liver and bone metastasis appeared 6 months after the operation. She died of cancer 11 months after the operation.     

Acute Peritonitis Caused by Intraperitoneal Rupture of an Infected Urachal Cyst: Report of a Case

Embryologically, the urachus is the tubular structure that connects the dome of the bladder to the umbilicus. Incomplete obliteration of the urachal lumen results in several anomalies. The most common urachal abnormality is the urachal cyst and, while intraperitoneal rupture of an infected urachal cyst is very rare, acute peritonitis resulting from intraperitoneal rupture is the most dangerous of all complications associated with urachal anomalies. We report the case of an 80-year-old woman who underwent an emergency laparotomy for lower abdominal pain and signs of acute peritonitis, which revealed intraperitoneal rupture of an infected urachal cyst. Infected urachal cysts with intraperitoneal rupture are often misdiagnosed as a common acute abdomen and result in emergency exploratory laparotomy. These patients should be managed by complete excision of the urachal remnant to prevent any malignant change occurring, as malignant changes have been reported. Received: September 6, 2001 / Accepted: July 2, 2002 Reprint requests to: M. Ohgaki, 6-2-118 Ichichoda-cho, Sakyo-ku, Kyoto 606-0954, Japan     

Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

IntroductionHere, 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 caseA 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 conclusionUrachal 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.     

Laparoscopic management of urachal cysts in adulthood

PURPOSE: Managing persistent and symptomatic urachal anomalies requires wide surgical excision. Such intervention is recommended to prevent symptom recurrence and complications, most notably malignant degeneration. However, traditional open excision is associated with significant morbidity and prolonged convalescence. We report our experience with the laparoscopic excision of urachal remnants as a less morbid, minimally invasive surgical alternative. MATERIALS AND METHODS: Between October 1993 and December 1999, 4 patients with a mean age of 43.3 years who had a symptomatic urachal cyst underwent laparoscopic radical excision of the urachal remnant. Using 2, 10 mm. and 1 or 2, 5 mm. ports the urachus and medial umbilical ligaments were divided at the umbilicus cephalad to the cyst. The specimen, which included the urachus, cyst and medial umbilical ligaments, was then separated from the bladder dome with or without the bladder cuff and removed intact. We reviewed the perioperative records to assess morbidity, recovery and outcome. RESULTS: All 4 procedures were completed successfully. No intraoperative or postoperative complications were reported at a mean followup of 15 months (range 2 to 24). Mean operative time was 180 minutes (range 150 to 210) and average hospital stay was 2.75 days (range 1 to 4). Pathological evaluation confirmed a benign urachal remnant in each case. All patients resumed normal activity within 2 weeks. CONCLUSIONS: To minimize the morbidity of radical excision the laparoscopic management of benign urachal remnants in adulthood is efficacious and our preferred method of management.     

Two case reports of eosinophilic cystitis--clinical review of 43 cases in Japan

Two cases of eosinophilic cystitis are reported. Case 1 was a 7-year-old boy with pollakisuria and case 2 was a 20-year-old man with right lower abdominal pain. They were suspected of bladder sarcoma after the examinations by cystoscopy, IVP, ultrasonography, CT and NMR-CT. Transurethral, percutaneous and open biopsies were performed and histological examination revealed massive infiltration of eosinophils mainly in the vesical muscle layer without malignant cells. We could establish the diagnosis only by biopsy. In case 1, IgE RAST was positive for tick and case 2 seemed to be allergic to rare beef. We presumed that they caused eosinophilic cystitis.     

A case of urachal remnant and review of the literature

Urachal remnants are not exceptional and are symptomatics if complicated. Ultrasound and CT scan identify most diseases entities originating from urachal remnant. Treatment consists on total exeresis because there is a risk of malignant degeneration. The authors report a case of urachal remnant and analysis the anatomopathologic, diagnosis and therapeutic features of urachal remnants in a review of the literature.     

Mucocele apendicular confundido con quiste de uraco infectado: un diagnóstico diferencial a tener en cuenta

ObjectiveTo report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis.PatientWe report the case of a 74 year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal.ResultsExploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele).ConclusionsAppendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei.     

Transitional cell carcinoma of urachus: a case report

We report a case of transitional cell carcinoma of urachus in a 72-year-old man. At follow up cystoscopy for past history of bladder cancer, we found a papillary tumor in the right orifice that came out to the bladder cavity intermittently. Although there was no cancerous lesion on the surface of the bladder mucosa, a submucosal eminence at the dome of bladder was observed. Sagittal magnetic resonance imaging (MRI) revealed an extravesical tumor (2 cm) at the position of urachus. Under the diagnosis of right ureteral cancer and urachal cancer, we performed right distal ureterectomy, ureteral reimplantation and total resection of urachus. Pathological examination revealed transitional cell carcinoma in the urachus and right ureter. The urachal cavity was isolated completely from the bladder cavity. Tumor infiltrated to the muscularis of the bladder dome from the urachal cavity, but there was no cancerous lesion on the surface of the bladder mucosa. Therefore, our diagnosis was urachal transitional cell carcinoma and right ureteral carcinoma.     

A case of ileus as a late complication of an ileal conduit in a patient with primary signet ring cell carcinoma of the bladder

A 69-year-old man visited our hospital with a complaint of dysuria. Intravenous excretory urography, ultrasonography and CT scan showed a tumor at the base of the bladder and the prostate. Transrectal needle biopsy revealed signet ring cell carcinoma. Radical cystectomy and ileal conduit were performed, and a histological diagnosis was a primary signet ring cell carcinoma of the bladder. No recurrence or metastasis was found either on ultrasonography or CT scan at 26 months after the operation. He suddenly suffered from severe abdominal pain, and died of hypovolemic shock by ileus as a late complication of an ileal conduit at 27 months after the operation. An ileus with extensive necrosis of small intestine and cancer recurrence at the junction of the ureter and ileal conduit were observed at autopsy.