Urachal Carcinoma: A Clinicopathologic Study of 46 Cases.
Jasreman Dhillon, Bogdan Czerniak, Charles C Guo. University of Texas M.D. Anderson Cancer Center, Houston
Background: Urachal carcinoma is a rare tumor that arises in the remnant of the embryonic allantoic stalk. Limited studies have been conducted of this tumor because of its rarity. Therefore, we determined its pathologic and clinical features in a large retrospective series.
Design: We retrospectively searched our surgical pathology files from 1990 to 2010 and identified 46 cases of urachal carcinoma. The specimens included partial cystectomy (n=33), radical cystectomy (n=6), and transurethral resection (n=7). The slides were reviewed for pathologic analysis. Clinical information was collected from patients' medical records.
Results: The mean patient age was 53.4 years. Sixteen were women, and 30 were men. The common presenting symptoms included hematuria, mucinuria, and abdominal pain. On gross examination, the tumors usually appeared as sessile nodular masses, with a mean size of 3.7 cm (range, 1.0–10.5 cm). All tumors was located in the dome (n = 45) except one in the anterior wall. All tumors consisted of adenocarcinoma, including mucinous (n = 36), enteric (n = 5), mixed mucinous and enteric (n = 2), and not-otherwise-specified (n = 3) types. Signet-ring cells were present in 23 cases, but urothelial carcinoma in situ was not identified in any cases. Patients had undergone partial (n = 33) or radical (n = 6) cystectomies. Seven patients had presented with metastasis and had undergone chemotherapy, with no further surgery. We evaluated cystectomy specimens and found that the tumors had invaded the muscularis propria (pT2) (n=8), perivesical tissue (pT3) (n=28), or the abdominal wall (pT4) (n=3). Clinical follow-up data were available for all patients, with a mean follow-up period of 40.9 months (range, 1-230 months). Twenty patients died of disease a mean of 30.6 months (range, 6-71 months) after diagnosis, and 26 were alive at a mean of 48.8 months (range, 1-230 months). Of the 8 patients with pT2 tumors, 6 were alive and 2 had died of disease. Of the 31 with pT3 or pT4 tumors, 16 were alive and 15 had died of disease.
Conclusions: The urachal carcinomas in our series are composed exclusively of adenocarcinoma, with the mucinous subtype being the most common. Urachal carcinoma often presents at an advanced stage and is associated with a poor clinical outcome. Although several staging systems are available, the TNM staging system for bladder cancer can be used for urachal carcinomas and provides valuable information to help predict patient outcome.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 9:15 AM
Platform Session: Section A, Monday Morning