[Carcinoma of the urachus: a case report]

A 34-year-old married woman complaining of macrohematuria was admitted to our institute. Cystoscopy revealed a broad-stalk, nonpapillary tumor at the urinary bladder dome, and cold-punch biopsy proved it to be a mucus-producing adenocarcinoma. Abdominal managnetic resonance imaging demonstrated a tumor extending from the umbilicus to the bladder dome, and chest computed tomography (CT) demonstrated a small lung tumor with calcification. Examination of the upper gostroinstestinal tract, barium enema, and colon fiberscopy did not reveal abnormalities. We therefore diagnosed an urachal carcinoma with lung metastases. Total cystectomy, umbilical-urachal resection, hysterectomy, ileal neobladder, and partial resection of lung were performed, followed by partial resection of the left lung using thoracoscopy. About 6 months later, chest CT demonstrated multiple metastases in the right lung. After treatment with three courses of chemotherapy (paclitaxel and carboplatin), the right lung was partially resected. Serum CEA and CA19-9 levels were used to follow her disease, since both were elevated before the surgery and at the recurrence. Both indicators returned to their normal ranges after treatment. Such cases require careful observation using imaging modalities and tumor markers.