Nese Nalan, Kesici Gonca, Lekili Murat, Isisag Aydin
Department of Pathology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
Anal Quant Cytol Histol. 2010 Jun;32(3):174-7.
Urachal carcinomas are rare tumors, and the majority of them are adenocarcinomas. Up to now, only 21 urachal urothelial carcinomas (UCas) have been reported. Here, we describe a case of high grade UCa arising from the urachal remnants.
A 66-year-old man presented with voiding difficulties. Prostate specific antigen (PSA) was 5.46 ng/mL. Prostatic adenocarcinoma (PCa) (Gleason score 6) was diagnosed by needle biopsies. After the diagnosis of high grade, muscle invasive UCa with intact mucosa on frozen examination of the dome of bladder wall during the radical prostatectomy operation (RPO), partial cystectomy was performed. Microscopically, among the tumoral islands, cystic structures lined by cells with a benign appearance, which are considered urachal remnants, were noted. Cytokeratin 7 and high-molecular-weight cytokeratin were strongly positive, PSA and carcinoembryonic antigen were negative. Radiotherapy was given for both UCa and PCa. Six months after the diagnosis, an undifferentiated tumor was detected in a bladder transurethral resection specimen; thus, chemotherapy was given. After 1 course of chemotherapy, the patient was doing well.
The origin of urachal carcinomas is usually obscured as it is a highly invasive carcinoma. The patient presented here was diagnosed incidentally during RPO. Although the stage was advanced, the tumor was detected before urachal remnants were destroyed. The treatment choice for urachal carcinomas is cystectomy. Adjuvant chemotherapy and radiotherapy are controversial.
脐尿管癌是罕见肿瘤，其中大多数为腺癌。截至目前，仅报道过21例脐尿管尿路上皮癌（UCa）。在此，我们描述1例起源于脐尿管残余组织的高级别UCa病例。
一名66岁男性因排尿困难就诊。前列腺特异性抗原（PSA）为5.46 ng/mL。经针吸活检诊断为前列腺腺癌（PCa）（Gleason评分6分）。在根治性前列腺切除术（RPO）过程中，对膀胱顶部进行冰冻检查时诊断为高级别、肌层浸润性UCa且黏膜完整，遂行部分膀胱切除术。显微镜下，在肿瘤结节中发现有良性外观细胞内衬的囊性结构，考虑为脐尿管残余组织。细胞角蛋白7和高分子量细胞角蛋白呈强阳性，PSA和癌胚抗原呈阴性。对UCa和PCa均给予放疗。诊断后6个月，在膀胱经尿道切除标本中检测到未分化肿瘤，因此给予化疗。1个疗程化疗后，患者情况良好。
脐尿管癌起源通常难以明确，因为它是一种侵袭性很强的癌。本文所述患者在RPO过程中偶然被诊断。尽管分期较晚，但在脐尿管残余组织被破坏之前就检测到了肿瘤。脐尿管癌的治疗选择是膀胱切除术。辅助化疗和放疗存在争议。
