[Adenocarcinomas of the urachus]

Tumors of the urachus account for 1% of all malignant bladder tumors and 20-39% of primary adenocarcinoma of the bladder. We report 4 cases (3 males, 1 female) of urachal adenocarcinoma. One of the patients had a signet ring cell tumor. The most common clinical sign was a suprapubic mass followed by hematuria. In three cases, cystoscopy revealed a mass at the level of the bladder dome. The IVP was normal in all but one patient in whom a filling defect at the level of the dome was evidenced by the cystogram. In one patient, CT revealed a fistulous track between the bladder and the tumor mass. Treatment was by surgery in all of the cases. Supratrigonal cystectomy and en bloc resection of the anterior infraumbilical abdominal wall was performed in 3 cases, followed by wide cystoplasty using intestine in 2 cases. One patient underwent radical cystectomy and Bricker urinary diversion. Two patients are alive and disease-free at 2 and 10 years, respectively. The other two patients have died; one following operation for high gastrointestinal hemorrhage, and the other at two years from generalized metastasis. The clinical findings reported in the literature, the diagnostic protocols and treatment of these tumor types are discussed.