Case contributed by Michael P Hartung
Diagnosis certain
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Citation, DOI, disclosures and case data
Citation:
Hartung M, Urachal adenocarcinoma. Case study, Radiopaedia.org (Accessed on 23 Jun 2024) https://doi.org/10.53347/rID-57372
Permalink:
https://radiopaedia.org/cases/57372
rID:
57372
Disclosures:
At the time the case was submitted for publication Michael P Hartung had no recorded disclosures.
View Michael P Hartung's current disclosures
Case published:
21 Dec 2017
Revisions:
6 times, by 5 contributors - see full revision history and disclosures
Systems:
Urogenital
Quiz mode:
Included
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Presentation
Hematuria. History of renal stones.
Patient Data
Age: 55 years
Gender: Male
From the case: Urachal adenocarcinoma
ct
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There a round, enhancing mass in the anterior dome of the bladder, which appears associated with the urachus. On the non-contrast images, a small non-obstructive calyceal stone is incidentally noted in the right kidney.
It is quite easy to overlook this subtle finding on axial images, but much more obvious on sagittal reformats. This patient likely had an urachal diverticulum and not a fully patent urachus, as the remainder of the obliterated urachus looks normal on sagittal images.It is essential to look at the bladder in all three planes when working up hematuria, as subtle mass may only be well appreciated in a single plane.
Finally, it is worth noting that the mass is also visible on the non-contrast images. Often when using narrow window/level settings, a subtle (or not-so-subtle) bladder mass may be visible on a more commonly performed non-contrast "renal stone protocol" CT when a patient is being worked up for hematuria, potentially diagnosing the disease at an even earlier time. Careful evaluation of the bladder is essential, even on non-contrast CT's, particularly in higher-risk patients.
Case Discussion
Primary adenocarcinoma of the bladder is rare. Although it is most classically associated with bladder exstrophy and patent urachus, two-thirds of cases are non-urachal (favoring the bladder base)and only one-third urachal. Risk factors include chronic mucosal irritation and urinary diversions. Patients can present with hematuria, irritative symptoms, mucus in the urine, or umbilical discharge.
Most cases of urachal adenocarcinoma occur near the bladder, with the remainder along the course of the urachus. These are distinguished by the prominent extravesicular components of the mass and often contain calcifications. They are typically large at presentation (mean 6 cm), high grade, and have diffusely invaded the bladder wall at diagnosis. Extravesicular spread and metastases are common.
Due to the location, urachal adenocarcinoma usually presents late and has a poor prognosis. Aggressive surgical excision is often performed including the posterior rectus fascia, peritoneum, and abdominal wall. In this case of pathology-proven adenocarcinoma, the patient was treated with partial cystectomy instead of more aggressive surgery, due to the small size and lack of invasion of adjacent structures.
Squamous cell and urothelial carcinoma can also occur in the urachus, but less frequently than adenocarcinoma.Metastatic adenocarcinoma to the bladder is more common than primary disease, and typically a late manifestation of cancer.
References
35 public playlists include this case
- FRCR 2B 5 by Sherif Mohsen Shalaby ◉
- Abdo VIVA 3 by Logan JR Walker
- URO 4-Ureter by HoangHuong
- core ped by ahmed alaa al-agamy
- gu 3/15 by Sandra M
- Abdo3 by Amy Gibney
- Promet Pediatrics by Turay Cesur
- nezar GU by nezar shlaka
- TC Viva 1 by Tom
- SJ GU 2 by Sarus Jain
- abdo 3 by Emily LI
- MC Abdo by Marianne Cossens
- Day 3: Cancer by Michael P Hartung ◉
- FRCR 2B AMR SAADAWY (part 11) (part 1) by Amr Saadawy
- ISODOPES GU tract by Vikrant Dhurandhar
- Portia's Genitourinary Playlist by Portia D'Anverrs ◉
- Exam Prep 3 by Miriam Leiderer
- PELVIS TUMORS by Deyan P. Ivanov
- Genitourinary by Michael P Hartung ◉
- RANZCR Part 2 Efilm Practice by Evyn Arnfield
- uro genital by Amr Ibrahem Elgendy
- Abdomen - ureters, urinary bladder by Edward Chan
- GI by Samuel Moniyong
- ABM Quiz by Dr Ali Basim
- GU by Dr Ali Basim
- Companion viva Genitourinary 2 by Nermeen Mohammed Abdelmonem
- 07/09/2022 by Joshua Yip
- Abdo for LisaSalam by Victor Tang
- WART ONLINE TEACHING_RENAL by Nathalie Falkner
- by Hung Dang
- 2b GUT by Ali Labeeb Alwan
- av frcr 4 by Avni K P Skandhan
- Abdo Jan 2022 by Henry Zhao
- OSCERs - 1 by Reuben Schmidt ◉
- FRCR by Mahak Sood
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