Primary urachal adenocarcinoma treated with partial cystectomy - Case report

Urachal adenocarcinoma is a rare non urothelial malignancy which arises from the urachus, which is a fibrous remnant of allantois that extends from the bladder to the umbilicus.

A 36 years old man presented with haematuria of 3 months duration. Cystoscopy revealed single solid growth at the dome of the bladder. Transurethral resection (TUR) biopsy showed invasive adenocarcinoma, on pelvic MRI there was 5 cm ∗ 3 cm bladder dome mass. Partial cystectomy with en-bloc resection of the urachus and umbilicus was done. The pathology result becomes mucinous adenocarcinoma and surgical margins were free.

Patients usually present with nonspecific symptoms. The most common manifestation is haematuria. Due to late symptomatic presentation it has poor prognosis. The mainstay of management is partial or radical cystectomy with en-bloc resection of the urachus and umbilicus. The role of adjuvant chemotherapy needs to be established.

Primary urachal adeno carcinoma is a rare disease. Due to the rarity of the case there is no standard clinical guideline for the management of urachal cancer. Its tendency for local invasion, late symptomatic presentation, and metastasis can lead to a poor prognosis. Timely diagnosis and early partial or radical cystectomy with enbloc resection of the urachus and umbilicus is critical for the survival of the patient.