World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website http://www.wjon.org

Case Report

Volume 8, Number 1, February 2017, pages 20-24

“Look Before You Leap”: Urachal Mass in Adults

Figures

Figure 1.
Figure 1. Ultrasound showed a moderate sized, ill-defined, heterogeneously hypoechoic mass (arrow) predominantly extending exophytically antero-superior to the dome of bladder with minimal indentation into the bladder wall. On color Doppler, no significant vascularity was noted.
Figure 2.
Figure 2. (a) Axial CT image of lower abdomen in venous phase showed moderate sized oval hypo-enhancing mass (arrow) with thick and irregular peripheral enhancement and central non-enhancing low attenuation area with ill-defined margins arising from the dome of the urinary bladder with exophytic growth anteriorly. Moderate thickening of the dome of the urinary bladder was noted. Rest of the bladder wall was normal. Infiltration into the surrounding region with moderate perilesional fat stranding was noted. Fat planes with recti muscles were maintained. (b) Axial plain CT image of lower abdomen showed a small focus of calcification (arrow) in the periphery of the lesion. (c) Axial CT image of lower abdomen in venous phase at a higher section showed infiltration into the surrounding region with moderate perilesional fat stranding (arrow). (d) Sagittal CT image of abdomen in venous phase showed mass arising from dome of urinary bladder with maintained fat planes with abdominal wall (arrow) and displacement of the small bowel loops. (e) Coronal CT image of abdomen in venous phase showed mass arising from dome of urinary bladder (arrow) with superior displacement of the small bowel loops.
Figure 3.
Figure 3. (a) Gross specimen of the resected mass in toto. Mass was surrounded by fibrofatty tissue. One aspect showed bladder mucosa along with bladder wall (red arrow). The other aspect of the mass shows umbilical skin (blue arrow). (b) Cut section of the gross specimen. Thick pus material was drained. The inner wall of cyst cavity showed irregular surface with slough (arrow).
Figure 4.
Figure 4. Photomicrograph showed dense polymorphic inflammatory infiltrate (arrow) in the cyst wall and also in the central area of bladder mucosa. The cyst wall showed lining made up of vascular granulation tissue.

Table

Table 1. Summary of Clinical Presentation, Imaging Features and Treatment of Infected Urachal Cyst and Urachal Carcinoma
 
FeaturesInfected urachal cystUrachal carcinoma
EtiologyAcquired urachal remnant diseaseAcquired urachal remnant disease
Occurrence in symptomatic urachal masses in adults [6]35%51%
Gender predilectionUnknownTwo-thirds in men
Age predilectionUnknown40 - 70 years
PresentationDysuria, palpable abdominal mass.Hematuria, palpable abdominal mass
UltrasoundComplex heterogeneous echogenic mass in the characteristic location with occasional intralesional gasFluid filled cavity in characteristic location with mixed echogenicity and calcifications
CT and MRIIll-defined heterogeneous enhancing mass with surrounding inflammationMixed solid cystic mass with calcifications (70%) and frequent bladder wall invasion
PrognosisGood prognosis. No additional follow-up required.Good prognosis in early completely resected cases. The 5-year survival rate in locally advanced and distant metastasis is 6.5-15%.