The Youngest Korean Case of Urachal Carcinoma
Seung Ryeol Lee1, Haeyoun Kang2, Moon Hyung Kang1
1Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam 463-712, Republic of Korea.
Insights
This study reports a rare case of urachal adenocarcinoma in a 26-year-old man, highlighting the importance of age in understanding the transition from benign to malignant urachal diseases.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Urachal anomalies are uncommon, often benign in children, but malignant transformation is rare, comprising <1% of bladder cancers.
- Malignant urachal disease is exceptionally rare, with few reported cases in young adults.
- Understanding the age-related pathogenetic transition from benign to malignant urachal conditions is crucial.
Purpose of the Study:
- To report a rare case of urachal adenocarcinoma in a young adult.
- To discuss the clinical presentation, diagnostic findings, and surgical management of urachal cancer.
- To contribute to the literature on the youngest reported cases of urachal carcinoma.
Main Methods:
- A 26-year-old male patient presented with gross hematuria.
- Diagnostic imaging included CT scan and cystoscopy.
- Surgical intervention involved laparoscopic partial cystectomy with wide excision of the urachus.
Main Results:
- CT revealed a large cystic mass over the bladder dome; cystoscopy showed an extrinsic mass.
- The final diagnosis was well-differentiated mucinous urachal adenocarcinoma, staged as pT3a.
- This represents the youngest Korean case and the fourth youngest reported case of urachal carcinoma in English literature.
Conclusions:
- Urachal adenocarcinoma can occur in young adults, necessitating thorough investigation of urachal masses.
- Early diagnosis and surgical management are critical for rare urachal malignancies.
- This case underscores the importance of considering urachal carcinoma in the differential diagnosis of bladder dome masses, even in young patients.
Abstract:
Urachal anomalies are relatively uncommon and result from incomplete obliteration of the urachus perinatally. In children, most urachal diseases including urachal cysts and sinuses are benign, and these can sometimes become secondarily infected. Malignant involvement of the urachus is rarely reported, one in 5 million people, accounting for 0.35% to 0.7% of all bladder cancers. There are only five cases of urachal cancer diagnosed at the age of twenties in English written literature. Age at the diagnosis of urachal carcinoma is important to understand pathogenetic transition from benign to malignancy. A 26-year-old man visited our clinic with gross hematuria starting a few months before. CT scan showed a 4.0 × 6.8 cm sized lobulated cystic mass over the bladder dome. Cystoscopy showed a ball-shaped extrinsic mass from the bladder dome with intact bladder mucosa. With an impression of urachal cancer, laparoscopic partial cystectomy with wide excision of urachus was performed. Final diagnosis was well differentiated mucinous urachal adenocarcinoma invading bladder muscle, staged as pT3a based on Sheldon's staging system. To our best knowledge, this case is the youngest Korean case of urachal carcinoma (the fourth youngest ever in English written literature).
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