Radiology Resident Case of the Week
Urachal Carcinoma
February 2, 1996
Jeff Goree
Peer Review Status: Not reviewed
Clinical Sx:
Suprapubic mass, abdominal pain, hematuria (71%), mucus
in the urine (25% and an almost pathognomonic finding).
Etiology/Pathophysiology
Arises from the remnants of the allantois which aids in blood formation in the third - fifth weeks of development and then forms the umbilical artery. The normally obliterated umbilical artery within the urachus forms the median umbilical ligament in the adult.
Pathology:
In 70% of adults, a minute lumen remains in the urachus which is lined by transitional cell epithelium. This epithlieum may undergo metaplasia leading to carcinoma. Almost always, it is mucinous adenocarcinoma (75-95% depending on the source).
Miscellaneous
Overall incidence: rare (0.2-0.3% bladder cancer)
Location: 90% juxtavesicle - supravesicle, anterior, and midline
Ages: 40-70 years old.
Sex: Males 3:1
Calcification?: Yes, but only 4%.
Prognosis: Poor. 5 year survival rate < 10%.
Imaging
Calcifications may rarely be seen on plain film. Ultrasound may demonstrate a supravesicle mass. However CT is the best hope for both the diagnosis and evaluation of metastatic disease.
DDX
Primary bladder carcinoma and invasive metastatic adenocarcinoma ( rectum, prostate, stomach, ovary, cervix, and uterus).
Key references
Pollack. Clinical Urography, 1990, Volume 2.
Dunnick et al. Textbook of Uroradiography. 1991.
Dahnert. Radiology Review Manual. 3rd. ed. 1995.
ACR Code
Keywords:
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