Masuda H, Nagamatu H, Kihara K, Fukui I, Oshima H
Department of Urology, Tokyo Medical and Dental University School of Medicine.
Hinyokika Kiyo. 1991 Mar;37(3):291-3.
Case 1: A lower abdominal large painful mass was recognized by palpation, CT scan and ultrasonography in a 64-year-old house wife. Urine cytology was negative. The mass at the dome of bladder was covered with normal epithelium cystoscopically. Aspiration cytology of the lower abdominal mass demonstrated no malignancy and total excision of urachal remnant with a portion of bladder wall was carried out. Histologically, the mass was an urachal cyst with granulomatous change infected with C group beta-streptococcus. Case 2: A 46 year-old male engineer complained of asymptomatic hematuria. Cystoscopic examination revealed a small bleeding lesion at the dome of bladder. Urine cytology was negative. CT scan and ultrasonography revealed a tiny cystic mass lesion with irregular density. Biopsy or aspiration cytology appeared difficult because of the size and localization of the mass. En bloc segmental resection of urachal remnant was carried out. Since intraoperative rapid histological examination of the specimen confirmed no malignancies, dissection of pelvic lymph node was not performed. Urachal cysts presented above were suspicious of malignant degeneration from findings of imaging examination. Either preoperative or intraoperative histological examination in such cases appears to be indispensable to avoid unnecessary extensive operation as well as to perform radical operation required for malignant lesions.
病例1：一名64岁的家庭主妇通过触诊、CT扫描和超声检查发现下腹部有一个疼痛性大肿块。尿液细胞学检查为阴性。膀胱顶部的肿块在膀胱镜检查下覆盖有正常上皮。下腹部肿块的抽吸细胞学检查未发现恶性肿瘤，遂对脐尿管残余物及部分膀胱壁进行了全切。组织学检查显示，该肿块为脐尿管囊肿，伴有肉芽肿性改变，并感染了C组β链球菌。病例2：一名46岁的男性工程师主诉无症状血尿。膀胱镜检查发现膀胱顶部有一个小的出血性病变。尿液细胞学检查为阴性。CT扫描和超声检查显示一个微小的囊性肿块病变，密度不规则。由于肿块的大小和位置，活检或抽吸细胞学检查似乎很困难。遂对脐尿管残余物进行了整块节段性切除。由于术中对标本的快速组织学检查证实无恶性肿瘤，因此未进行盆腔淋巴结清扫。上述脐尿管囊肿从影像学检查结果来看怀疑有恶性变。在此类病例中，术前或术中组织学检查似乎必不可少，以避免不必要的广泛手术，并对恶性病变进行所需的根治性手术。
