Department of Urology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., 104, Taipei, Taiwan.
BMC Surg. 2022 Mar 21;22(1):105. doi: 10.1186/s12893-021-01430-w.
The urachus is the embryological remnant of the cloaca and allantois. Failure of its regression can cause diseases any time after birth. It is difficult to differentiate an abscess from urachal adenocarcinoma based on the clinical presentation and image findings. Cystitis glandularis reflects chronic irritation of the bladder urothelium, and tumor-like florid cystitis glandularis can be misdiagnosed as malignancy. We report a patient with concurrent urachal abscess and florid cystitis glandularis which increased the resemblance of malignancy.
A 57-year-old female was incidentally found to have a heterogeneous pelvic mass abutting the urinary bladder. A cystoscopy examination revealed protruding tumors located in the bladder dome. Her blood test results were all normal, and urinalysis showed microscopic hematuria. Urachal cancer was diagnosed and en bloc excision of the umbilicus, tumor, and the involved bladder dome was performed. Pathology revealed urachal abscess with concurrent cystitis glandularis within the urinary bladder. No malignancy was identified in the resected specimen.
It is challenging to distinguish urachal abscess from a malignant tumor based on the clinical presentation and imaging studies. As in our case, the coexistence of urachal abscess and tumor-like florid cystitis glandularis increased the resemblance to a malignancy. This is the first reported case of the concurrence of these two disease entities, and emphasizes that the detection of bladder tumors on cystoscopy is not sufficient to make the diagnosis of urachal cancer with bladder involvement.
脐尿管是泄殖腔和尿囊的胚胎残留。其退化失败可导致出生后任何时间的疾病。根据临床表现和影像学检查，很难将脓肿与脐尿管腺癌区分开来。腺性膀胱炎反映了膀胱尿路上皮的慢性刺激，而瘤样的滤泡性膀胱炎可能被误诊为恶性肿瘤。我们报告了一例同时并发脐尿管脓肿和滤泡性膀胱炎的患者，这增加了恶性肿瘤的相似性。
一名 57 岁女性偶然发现盆腔内有一个不均匀的肿块紧贴着膀胱。膀胱镜检查显示位于膀胱穹窿处有突出的肿瘤。她的血液检查结果均正常，尿分析显示镜下血尿。诊断为脐尿管癌，并进行了脐部、肿瘤和受累膀胱穹窿的整块切除。病理显示脐尿管脓肿合并膀胱内的滤泡性膀胱炎。切除标本中未发现恶性肿瘤。
根据临床表现和影像学研究，很难将脐尿管脓肿与恶性肿瘤区分开来。就像我们的病例一样，脐尿管脓肿和瘤样滤泡性膀胱炎的共存增加了恶性肿瘤的相似性。这是首例同时并发这两种疾病的报道，强调了膀胱镜检查发现膀胱肿瘤不足以诊断伴有膀胱受累的脐尿管癌。
