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case report: cancer of the urachus
Apresentação do caso
63 years old, male, with a bladder mass on ultrasound in May/2019. He underwent cystoscopy with biopsy, Anatomopathological (AP): Moderately Differentiated Invasive Mucinous Adenocarcinoma of probable etiology of the urachus. In June/2019, he performed Partial Cystectomy with en bloc resection of the urachus, part of the left colon for suspected neoplastic invasion and colostomy, whose PA confirmed Mucinous Adenocarcinoma of the Urachus infiltrating the muscular wall of the urinary bladder measuring 12.5x7.0 cm with margins disease-free, neoplasm-free colon segment, Sheldon stage IIIA. Radiotherapy followed by chemotherapy x 6 cycles with 5-Fluoraucil and cisplatin. PET/CT of January/2020 negative for neoplasia. Computed tomography of the chest and abdomen of August/2020 showed multiple lung and liver lesions suggestive of metastases, confirmed with liver biopsy with AP: Metastatic Mucinous Adenocarcinoma with signet ring cells in liver tissue. In September/2020, he was hospitalized with abdominal pain and jaundice and progressed to death 16 months after diagnosis
Adenocarcinoma of the urachus is an uncommon neoplasm associated with poor prognosis. The most common histological type is mucinous adenocarcinoma. Partial cystectomy is a feasible and safe option. Adherence to oncologic surgical principles, with extended pelvic dissection, including umbilicus, tumor, and the entire urachus, with negative margins, cures most patients with localized urachal carcinoma. However, at diagnosis, most urachus tumors invade the bladder, and in these cases they are associated with a poor prognosis due to the advanced stage and extravesical tumor growth, which favors local recurrence and distant metastasis. It has a high recurrence rate (20%-38%) and the most common sites are the pelvis (37%), bladder (34%), lungs (28%) and lymph nodes (18%); adjuvant or validated neoadjuvant treatments are needed. However, the effectiveness of the regimens used, largely based on 5-fluorouracil and cisplatin, is not yet established. The choice of treatment, whether chemotherapy-radiotherapy, is based on isolated case reports.
Surgical removal is crucial for the survival and cure of patients with non-metastatic disease. Due to the rarity of the disease, it is difficult to predict the best adjuvant alternatives in advanced cases.
uracus cancer, advanced disease, oncorurology
TALITA SPOSITO, MAYSA LEMOS SIMOSONO, VINICIUS CESAR FURQUIM, TADEU AVILA CASTRO, LILIA FREITAS OLIVEIRA, PEDRO HENRIQUE MAIA NOGUEIRA SILVA, MONIQUE GODINHO ROSA, PETRINE ROCHA MENDES CHAVES, LUIZ GUSTAVO HERMOGENES PEREIRA, CLEUBER BARBOSA OLIVEIRA