A case of urachal adenocarcinoma: BMJ
A 40-year-old male patient presented with ulcerative swelling with foul smelling discharge from lower half of abdomen for last 3 months. He had a history of haematuria with increased frequency of micturition for last 6 months accompanied by loss of appetite and subsequent weight loss. There was no history of nocturia, urgency or incontinence.

On physical examination, he was found to have an ulceroproliferative growth around 5×3 cm size in the infraumbilical region with urinary discharge near one end. It was small to begin with and progressively increased in size to reach the present state.

Imaging was ordered for further evaluation of the mass. On ultrasound, he was found to have a growth around 6×8 cm in size involving the anterior wall and dome of the urinary bladder reaching till abdominal wall with absence of bilateral hydronephrosis.

On Histopathological Examination the patient was found to have low-grade adenocarcinoma with desmoplastic reaction and atypical cells. The overlying urothelium had only reactive changes, and underlying bladder muscle was invaded with cancerous cells.

On further evaluation with immunohistochemistry (IHC) he was diagnosed to have non-metastatic urachal adenocarcinoma (UC).

Learning points
• Primary urachal adenocarcinoma is a rare entity. It has to be differentiated from adenocarcinomas arising from other organs in vicinity like colon.

• The disease can present with local or distant metastasis. A thorough metastatic evaluation is necessary. The prognosis is poor with metastasis.

• Surgical excision with negative margin is the gold standard of treatment. Chemoradiation is reserved for patients with positive margin or metastasis.

Read more here: http://casereports.bmj.com/content/2018/bcr-2018-226207.full
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Dr. M●●●●●●h J●●●●●l
Dr. M●●●●●●h J●●●●●l General Surgery
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Sep 17, 2018Like