Carcinoma of the Urachus

Abstract

SUMMARY Five cases of carcinoma of the urachus are reported. The factors contributing to the poor prognosis are discussed. Improved survival may follow earlier diagnosis; a biopsy should be taken from all isolated tumours at the bladder apex, and if the tumour is found to be an adenocarcinoma the urachus is the most likely site of origin. Treatment is by radical surgery in early cases; the place of radiotherapy is as yet undecided.

Sigmoid-Urachal-Vesical Fistula Associated with Urothelial Carcinoma in an Adult Male: Case Report

“…Squamous cell carcinomas and urothelial carcinomas each comprise approximately 3% of urachal malignancies, and sarcomas comprise 5 to 10% of urachal malignancies (6,7). Urachal tumors are typically silent due to an extraperitoneal location and extending superiorly toward the umbilicus; consequently, the majority of patients exhibit local invasion or metastatic disease at the time of presentation (7,9). Urachal carcinomas may be confused with primary tumors of the bladder dome; unlike vesical tumors, however, urachal tumors have a propensity to grow in the perivesical space toward the umbilicus and are found located in the middle of the urachus or near the umbilical end (7,8).…”

Primary adenocarcinoma arising in a vitello-intestinal duct remnant at the umbilicus

“…2, 3) of the tumour showed it to be a columnar-cell, papillary, mucusproducing adenocarcinoma of low-grade malignancy -a picture which is consistent with a vitello-intestinal duct origin. However, since the majority of urachal tumours resemble intestinal tumours histologically (Mostofi, Thomson, and Dean, 1955;Nadjmi, Whitehead, McKiel, Graf, and Callahan, 1968; Grogono and Shepheard, 1969) this does not help in the differentiation of the tissue of origin, which will depend more on the anatomical and clinical features of the case.…”

“…Urachal tumours are usually found at the apex of the bladder, 75 per cent occur in males (Nadjmi and others, 1968), and the initial symptom is commonly related to micturition. A suprapubic mass is palpable in 80 per cent of cases at the time of presentation (Grogono and Shepheard, 1969). The tumour spreads in the retropubic space and despite radical surgery the prognosis is poor, with a 5-year survival rate of 8 per cent (Nadjmi and others, 1968).…”

Signet-Ring Cell Carcinoma Involving the Urinary Bladder

“…Based on anal ysis of the present series, we feel that the fol lowing factors contribute to this exceedingly poor prognosis: (1) an insidious growth is often asymptomatic and docs not encourage the patient to seek early medical attention; (2) rapid development and early metastasis are frequently demonstrated; (3) understag ing of the tumor misleads the treatment of choice; (4) less aggressive surgical procedure has been chosen until recently in spite of the great morbidity and mortality which were well documented [15,16,20,21]; (5) radio therapy seems to be of no benefit for adeno carcinoma [23,24], Whitehead and Tessler [24] claimed in 1971 that en bloc segmental resection brought the best prognosis, a 5-year survival of 25% in 75 patients with urachal carcinoma. In view of the high mortality, however, we believe that radical cystectomy, together with the excision of peritoneum, urachus, umbilicus and abdominal wall [6,18,23,26] should be undertaken once the transurethral biopsy has confirmed the ade nocarcinoma with or without signet-ring cells in it.…”