U J - Spring 2012.pdf 533Vol. 9 | No. 2 | Spring 2012 |U R O LO G Y J O U R N A L Keywords: urachus, urachal adenocarcinoma, urinary bladder neoplasms INTRODUCTION Urachal adenocarcinoma is a very rare type of all the bladder neoplasms, typically arises in the remnant of the allantoic stalk. Its annual incidence is estimated to be 1 in 5 million individuals and the majority of patients are in the 5th and 6th decades of life with presenting symptoms of mucusuria, hema- turia, irritative voiding symptoms, and palpable suprapubic mass. Urachal adenocarcinomas typically involves the wall of the bladder and may ex- hibit ulceration of the overlying urothelium. We here report a case with a huge dimensions of urachal adenocarcinoma without involvement of the bladder wall. CASE REPORT examination revealed a midline infra-umbilical mass. Ultrasonographic evalua- tions showed that it was not consistent with an obstructed bladder. Computed to- mography and magnetic resonance imaging demonstrated lower abdominal wall - ate it as a malignancy. There was only an irregularity at the dome of the bladder without a sign of involvement. The patient underwent partial cystectomy with resection of the urachus, posterior rectus fascia, and overlying peritoneum. The tumor measured 9 × 6.5 × 5 cm with a weight of 77 g. A bilateral pelvic lymph node dissection was performed. Frozen section of the bladder margin was negative. Enis Rauf Coskuner,1 Burak Ozkan,2 Veli Yalcin2 Urachal Adenocarcinoma Big Dimensions Without Involvement of the Bladder Wall Corresponding Author: Enis Rauf Coskuner, MD School of Medicine, Acibadem University; Department of Urology, Acibadem Bakirkoy Hos- pital, Halit Ziya Usakligil Cad. No: 1, 34140 Bakirkoy, Istanbul, Turkey Tel: +90 542 421 55 50 E-mail: enisraufcoskuner@ hotmail.com Received May 2010 Accepted December 2010 1School of Medicine, Acibadem University; Department of Urology, Acibadem Bakirkoy Hospi- tal, Istanbul, Turkey 2Department of Urology, Acibadem Bakirkoy Hospi- tal, Istanbul, Turkey Case Report 534 | The duration of catheterization and hospital stay were 5 days. There were no intra-or postoperative - teric type urachal adenocarcinoma with abundant computed tomography and bone scan was negative for distant metastases. After evaluation in our department of oncology, we did not need any chemotherapy or radiation. The patient remains free from the disease after a DISCUSSION The natural disease course of urachal adenocar- cinoma is hampered by the paucity of reported cases. Urachal adenocarcinomas typically involve the bladder wall and exhibit any kind of deforma- tion of the mucosal layer. Their size ranges from a small mass to a bulky tumor. The clinicopathologic criteria for diagnosing urachal adenocarcinoma are tumor location in the bladder wall, demarcation line between tumor and surface epithelium, and exclusion of a primary adenocarcinoma in another location with secondary bladder involvement. In one recent report of 130 patients with ura- chal masses, two predictors for malignancy were found; age over 55 years and presence of hema- - tween partial cystectomy and radical cystectomy. Surgical margins and tumor grade were independ- ent predictors of mortality. Urachal adenocarcinomas’ response to radiothera- py and chemotherapy is modest and the only effec- tive therapeutic approach is surgical eradication. Its poor prognosis is duo to late presentation of symptoms leading to advanced stage at diagnosis, a propensity of early local invasion, and distal me- tastasis. Our case is a rare one of a big, enteric type ura- chal adenocarcinoma, with abundant mucin forma- tion, but without the bladder wall involvement. We could not see enough data about the dimensions of urachal adenocarcinomas and their behaviors. Tu- is another subject to examine for large serial ones. CONFLICT OF INTEREST None declared. Figure 1. Magnetic resonance imaging showing a supravesical mass. Figure 2. Microscopic view of the urachal adenocarcinoma. Case Report 535Vol. 9 | No. 2 | Spring 2012 |U R O LO G Y J O U R N A L Urachal Adenocarcinoma | Coskuner et al REFERENCES 1. Cho SY, Moon KC, Park JH, Kwak C, Kim HH, Ku JH. Outcomes of Korean patients with clinically localized urachal or non- urachal adenocarcinoma of the bladder. Urol Oncol. 2011. 2. Hong SH, Kim JC, Hwang TK. Laparoscopic partial cystec- tomy with en bloc resection of the urachus for urachal ad- 3. Johnson DE, Hodge GB, Abdul-Karim FW, Ayala AG. Urachal 4. Grignon DJ, Ro JY, Ayala AG, Johnson DE, Ordonez NG. Primary adenocarcinoma of the urinary bladder. A clinico- 5. Ashley RA, Inman BA, Sebo TJ, et al. Urachal carcinoma: clin- icopathologic features and long-term outcomes of an ag- 6. Siefker-Radtke AO, Gee J, Shen Y, et al. Multimodality man- agement of urachal carcinoma: the M. D. Anderson Cancer