These urachal remnants are often subject to infection, and the route of infection may be lymphatic, hematogenous or vesical. The lining may be urothelial, flattened atrophic, or glandular type. We report a case of 33yearold woman with pelvic pain and dysuria who was diagnosed with infected urachal cyst. Urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. Computer tomography showed a cystic mass closely related to the.
Urachal cysts form when both the umbilical and vesical ends of the urachal lumen close while an intervening portion remains patent and fluid filled. Apr 11, 2017 urachal cancer is a type of bladder cancer, making up less than 1% of all bladder cancers. The patient presented with acute symptoms of leg swelling, pain and dyspnoea, and a vague awareness of lower abdominal distension. Abscess of urachal remnants presenting with acute abdomen. The cyst showed ovoid protrusion into urinary bladder cavity from the dome 3. A characteristic ct feature of urachal carcinoma is a midline mass anterosuperior to the dome of the bladder with lowattenuation components, which represent pools of mucin at pathologic examination, 1. The histopathology confirmed a surgically opened, but otherwise well encapsulated cyst 10. A final diagnosis was made after the mass was resected and histopathology confirmed an endometrioma originating from an urachal remnant. Computer tomography showed a cystic mass closely related to the anterior.
Select imaging studies and histopathology are presented in this case report. A urachal cyst is a remnant cyst that forms between the umbilicus and the bladder. Urachal cysts are rare defects found mostly in young children and hence medical ultrasound of the abdomen, bladder and pelvis is the most used diagnostic tool combined with mri scan and ct scan in older patients who can remain still during a scan. Histopathology slide reveal in this case the lumen shows fibro collagenous cyst wall lined by single layer of cuboidal to columnar epithelium. Acquired urachal remnant diseases, including infections and neoplasms, cause. Clinical and histopathological profile of lesions of. They are very rarely seen in adults because the urachus is normally obliterated in early infancy. May 08, 2018 chiarenza sf, scarpa mg, dagostino s, fabbro ma, novek sj, musi l. Xanthogranulomatous cystitis xc is a benign disease of unknown etiology. Tumors are rare, 95% are epithelial, and the remainder is mesenchymal tumors. They appear as cystically dilated epitheliallined structures. Request pdf clinical presentation and urachal remnant pathology. Urachal diseases are rare and may develop from a congenital anomaly in which a persistent or partial reopening of the fetal communication between the bladder and the umbilicus persists. The diagnosis of this entity is not always easy because of the rarity of these diseases and the atypical.
A 40yearold caucasian woman presented with subacute abdominal pain and a suprapubic mass. Without going into details because i dont quite understand it myself this cyst forms at birth at the top of the bladder and can cause abdominal pain, leaking of urine out of the tummy button and can get infected. The urachus is an embryologic remnant which degenerates after the birth. Transitional cell carcinoma in urachal cyst springerlink. The small connection existing between the urachus and the bladder can clear the way for a bacterial infection, which becomes manifest with fever, abdominal pain and may even resemble an acute abdomen, a palpable abdominal mass or a urinary infection. The most frequently reported urachal anomalies in adults are infected urachal cyst and urachal carcinoma. Urachal anomalies were classified into 1 of 4 categories based on examination findings, radiographic assessment and pathological analysis, including urachal cyst, urachal sinus, urachal diverticulum and patent urachus. A patent urachus accounts for 50% of the anomalies, urachal cyst for 30%, umbilical sinus for 15% and bladder diverticulum for 35%. Histopathology revealed transitional cell carcinoma in a urachal cyst. I had an operation to remove an urachal cyst last friday. About 90% of all urachal malignancies are adenocarcinomas, and interestingly urothelial and squamous cell carcinomas are rare. Any urachal remnant with drainage at the umbilicus was classified as a urachal sinus. We suggested a diagnosis of urachal cyst with possibility of malignancy. Computerized tomography diagnosis of urachal cyst harboring.
We discuss a rare presentation of an unusual case of endometrioma. Urachal cyst is a rare pathology in adult women, and this pathology. Adenocarcinoma of urachal cyst associated with pseudomyxoma. Urachal cyst definition of urachal cyst by medical dictionary. Macroscopically, the specimen consisted of umbilical skin with an attached deep fibrous cord that expanded to form an intact unilocular cyst. The pathologists report said the margins of the cyst looked good the cancer cells had not reached the wall of the urachal cyst. The structure was removed, and after analysis macroscopic morphology, wall histopathology and biochemistry of the contained fluid, it was determined to be a urachal cyst. Implications for treatment symptomatic pediatric urachal remnants are frequently.
Failure of complete urachal lumen closure causes urachal cysts or a free communication between the bladder and the urachus in which urine leaks from the umbilicus histology of urachal cyst. It was possible to reach the exact diagnosis only after histopathology such a large urachal cyst has only been reported in a n adult. Apr 09, 2020 ultrasonography is helpful when a mass is present. Pdf clinical and histopathological profile of lesions of. Failure of complete urachal lumen closure causes urachal cysts or a free communication between the bladder and the urachus in which urine leaks from the umbilicus. Urachal cyst genetic and rare diseases information. Pdf an urachal cyst is a sinus remaining from the allantois during. Resection of urachal anomalies in dogs with recurrent lower. Most cases are referred for treatment once diagnosed either clinically or radiographically with ultrasound or computerized tomography.
Chiarenza sf, scarpa mg, dagostino s, fabbro ma, novek sj, musi l. We present a unique case of an infected urachal cyst visualized on a series of ct scans in an adult patient. Diagnosis of an infected urachal cyst was confirmed on. Sometimes, it is called a sinus remnant that appears as a pale yellow mass in the area in the abdomen and the pelvis, also called the extraperitoneal space. The only true type of urachal cyst is that formed by the proliferation of epithelial cell masses and their breaking down in the central parts. Mar 16, 2020 urachal remnants are sometimes found in the biopsies from dome or anterior wall of the bladder. Urachal cancer is a type of bladder cancer, making up less than 1% of all bladder cancers. Defective obliteration of the urachus leads to urachal abnormalities. The cyst may be located at any point between the bladder and the.
Peripheral calcifications in the softtissueattenuation mass occur in 50%70% of cases. Although it normally disappears prior to birth, part of the urachus may remain in some people. Characteristic tubular structures showing the typical histology of an urachal remnant was. The urachus is a remnant of a channel between the bladder and the umbilicus belly button where urine initially drains in the fetus during the 1 st trimester of pregnancy. Sep 29, 2017 a urachal cyst is a saclike pocket of tissue that develops in the urachus, a primitive structure that connects the umbilical cord to the bladder in the developing baby. Peritoneal mucinous cystadenocarcinoma of probable urachal. Cancers can arise from any of the urachal remnant compartments, but the vast majority originates from the canal epithelium carcinoma in adults. Urachal cyst genetic and rare diseases information center. Cystoscopy was performed intraoperatively to exclude sinus communication with the bladder. It may be useful in identifying cysts of the umbilicus. An urachal cyst is a cyst formed in the urachus, a primordial canal that links the bladder to the umbilical cord at the first stages of fetal development. The other end of the cyst was connected by a segment of fibrofatty tissue to the bladder mucosa. Clinical presentation and urachal remnant pathology.
Sep 17, 2009 we suggested a diagnosis of urachal cyst with possibility of malignancy. The most common histopathological diagnosis was umbilical sinus four cases, of which two were of pilonidal sinus. The tumor morphology showed as typical muci nous adenocarcinoma. The pathology reports indicated acute and chronic inflammation with dense fibrotic tissues. The treatment of choice for urachal pathology is the complete excision of the complicated lesion. We describe a case of a 32 year old male caucasian who presented with a tender, midline, infraumbilical mass and purulent umbilical discharge. The cyst was wholly above the dome of the bladder, not attached to it, not involved with it separate, it seems. These are lined by urothelium, cuboidal, flat or atrophic epithelia figures 1, 2, 3. An uninfected urachal cyst was found in a 79yearold male who had died of bile duct carcinoma.
The most frequent anomaly in adulthood is the urachal cyst. An infected urachal cyst is one of the urachal abnormalities and this pathology is rare in adult women. Fig 3 ct section showing the cyst fig 4 a urachal cyst b bladder end c umbilical end the ct fig 1,2,3 scan was reported as cystic lesion 4cm inferior to the umbilicus on the inner surface of anterior abdominal wall which was a benign cyst or collection. Any information contained in this pdf file is automatically generated from. The cyst has a small connection to the bladder and can become infected, leading to its diagnosis. Urachal cyst is a rare pathology in adult women, and this pathology should be considered in the differential diagnosis of acute abdomen. The most frequent initial symptom is haematuria which occurs when the urachal tumour has penetrated the bladder wall, but mucinuria mucin in the urine, local pain or swelling, recurrent local or urinary tract infections and umbilical discharge can but is not always be seen.
Giant urachal cyst in utero, australian and new zealand. A rare case of urachal cyst in a 35 year old malea case. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Such cyst is found somewhere along the allantois canal. A fetal urachal cyst refers to a urachal cyst occuring in utero. Umbilical cord urachal cysts originate from an extraabdominal urachal system. Rarely it can cause peritonitis and abdominal symptoms. The cyst may be located at any point between the bladder and the umbilicus. Urachal cysts occur infrequently in adults and are rarely reported in the literature. Its formation occurs during the development of an embryo. This report describes the case of a mucinous cystadenocarcinoma of probable urachal origin that presented with mass effect, precipitating deep venous thrombosis and pulmonary embolism. Urachal adenocarcinoma with a concomitant urachal remnant. Diagnosis of an infected urachal cyst was confirmed on magnetic. T1 computerized tomography diagnosis of urachal cyst harboring teratoma.
Laparoscopic excision of urachal cyst in pediatric age. Histopathology of vesicourachal diverticula was characterized by the presence of a tubular structure lined with urothelium, often. A differential diagnosis of urachal cyst or a duplication cyst of sigmoid colon. Urachal cancer genetic and rare diseases information center. The data displays the heterogeneous presentation and histology of these. Congenital urachal abnormalities are twice as common in men as in women. The cyst can drain through the umbilicus, bladder, or through the peritoneum and into intraperitoneal organs. Jun 25, 2009 urachal cyst is one of a spectrum of urachal abnormalities most commonly found in children. Urachal cysts arise out of desquamation and degeneration of the urachal epithelium. Urachal cysts can develop at any age, but typically affect older children and adults. Urachal remnants are sometimes found in the biopsies from dome or anterior wall of the bladder. Ultrasonography can also be used to identify a patent urachal fistula between the umbilicus and bladder. Urachal cancer can exist for some years without any symptoms.
Histopathology of excised tissue was performed in 28 of 33 dogs figures 4 and 5. The urachal disorders include sinus or cyst formation, infections, and calculus formation or calcification. A certain amount of obliteration of the urachal canal from above downwards appears to take place occasionally throughout life as witnessed by the discovery even in subjects of over. Aug 14, 2019 histopathology of excised tissue was performed in 28 of 33 dogs figures 4 and 5. Pdf urachal cyst with xanthogranulomatous cystitis. Histology revealed the mass to be an urachal mucinous cystic tumour of low malignant potential.
On surgical exploration, the cystic mass was found superior to and separate from the urinary bladder dome. The channel of the urachus usually seals off and obliterates around the 12 th week of gestation and all that is left is a small fibrous cord between the. Histopathological assessment confirmed an infected urachal cyst. It may or may not communicate with the vertex of the fetal bladder. The urachus is a structure normally only present during development in the womb that connects the bellybutton and the bladder. The diagnosis of this entity is not always easy because of the rarity of these diseases and.
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