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This report present one case of mucinous adenocarcinoma of the urachus, a very uncommon tumour with eccentric clinical behaviour. It includes a brief description of both its macro and microscopic appearance, establishing the differential diagnosis both with adenocarcinoma of the vesical dome and the metastatic tumours which can affect the bladder. Also, there is a brief comment on the main anatomo-clinical characteristics of these tumours.

In the clinic, 23 patients were operated on the weeping umbilicus. A patent urachus was revealed in 10 patients: its complete patency--in 3, a stone-containing cyst--in 3, phlegmon of the abdominal wall--in 4. Total excision of the urinary duct was performed in all the patients.

Cancers of the urachus are very infrequent, making up 0.1% to 0.7% of all bladder tumors. This type of tumor affects male subjects in 60% to 75% of cases, in the 5th or 6th decade of live. In more than 90% of all cases, the lesion is a mucosecretory adenocarcinoma developing from embryonic remains within the wall of the bladder and respecting the superficial urothelium of the bladder, which is affected only secondarily, contrary to what occurs in the other adenocarcinomas of the bladder. The pathogenesis remains controversial, especially in the role of urachus patency and of bladder carcinogens. The diagnosis is most often established late, because of a long clinical latency. It is mainly based on ultrasonography and CT scan. Explorations of the bladder are useful only at an advanced stage. The prognosis is very poor, survival at 5 years ranging from 6.5% to 25% according to the authors. The treatment is mainly surgical. Only extensive resection with partial cystectomy extending to the peri- and supravesical environment, including the peritoneum and the umbilicus, and associated with pelvic lymphadenectomy may give some hope. Chemotherapy and radiation therapy, either alone or adjuvant, are disappointing. The prognosis may be improved only by an early diagnosis.

We report a case of mucin-producing adenocarcinoma of the urachus. Preoperative diagnosis was established by computerized axial tomography. An en bloc resection was performed, including the urachus with supravesical mass and bladder dome.

Urachal carcinoma is a very rare tumor that occurs primarily in middle-aged and elderly men. Most are mucinous adenocarcinomas. The lesion's poor prognosis primarily reflects its clinically silent behavior in its early stages. Therefore, aids to preoperative diagnosis and tumor staging may be of benefit. Conventional radiographic techniques have not proved very effective at diagnosing urachal lesions. Magnetic resonance imaging (MRI) may be particularly useful in this regard, mainly due to its multiplanar imaging capability. We review the clinical, pathological, and radiological features of urachal carcinoma, and include a description of the MRI appearance of two cases.

Signet-ring cell carcinoma of the urachus and bladder is a rare lesion. Its histological picture is unique and similar to linitis plastica of stomach. The tumor arises through metaplasia of the totipotent transitional epithelium lining the urachus. It is a highly malignant tumor with propensity for local invasion and distant metastasis, and carries a uniformly poor prognosis. Herein we report one such rare case of urachal carcinoma who is free of disease for 2 years after surgical treatment.

A case of urachal signet-ring cell carcinoma is reported and compared with the 18 previously reported cases. This tumor appears aggressive, with a five-year survival rate of 27 percent. Only 1 patient achieved a five-year disease-free survival.

Urachal abnormalities are very rarely encountered in adults. Though the urachus is normally obliterated in early infancy, it may cause a lower midline lesion in adults. Urachal abnormalities can be classified into five groups: patient urachus, urachal sinus, vesicourachal diverticulum, urachal cyst, and alternating sinus. The medical records of Ochsner Medical Institutions were reviewed for the 31-year period 1957 to 1988. Forty-one patients were identified as having anomalies of the urachus, 11 of them in the adult age group (older than 17 years). All cases were documented by pathologic examination. All patients were treated surgically, with no resultant morbidity or mortality.

Two cases of rare urachal anomalies in the adult are described, including one acquired patent urachus and one giant urachal cyst. The presenting symptoms and signs included pyuria, fever, lower abdominal pain and palpable abdominal mass. The correct preoperative diagnosis was made after sonography. The clinical and radiographic features and magnetic resonance imaging are presented. Stone formation and the huge capacity of the urachal cyst are first reported. Excision of the urachal tract with resection of the bladder dome and cauterization of the cystic wall with stone removal were performed in that order. When a young adult presenting with a wet umbilicus, acute abdominal pain or a lower midline abdominal mass, the possibility of an infected urachal anomaly should be considered in the differential diagnosis.

The clinical, cytologic, histologic and ultrastructural findings in a mixed adenocarcinoma and neuroendocrine carcinoma of the urinary bladder urachus, an extremely rare tumor only recently described, are presented for a 31-year-old woman who died of widespread metastatic disease six months following the initial diagnosis and treatment. Cytologic study of voided urine and bladder washings disclosed the presence of malignant cells with the features of a small cell carcinoma; retrospectively, scarce adenocarcinoma cells were also identified in those specimens. Histologic study of resection specimens, including the use of special stains and electron microscopy, confirmed the presence of a small cell component, consistent with the poor prognosis in this case. Image analysis measurements of the malignant cells suggested a high proliferation rate.

Clinical findings, therapy, and prognosis of 20 calves with urachal problems were studied and are discussed. Ultrasonography proved to be a valuable adjunct diagnostic procedure to manual palpation. It allowed exact evaluation of the intraabdominal umbilical cord size and was an important aid in the selection of the correct therapy. A complete omphalourachectomy was performed in calves with an extra- and intraabdominal umbilical cord diameter of up to 10 cm, otherwise drainage was established. Based on our results prognosis for calves with urachitis is independent of the size of the umbilicus and can be judged as favourable in cases without systemic complications.

A 35-year-old man had been treated with sulfamethizole on 6 occasions because of recurrent urinary tract infections. Furthermore, he had experienced diffuse monosymptomatic hematuria for 15 years. Cystoscopy and biopsy demonstrated irregular intestinal mucosa. Physical examination and intravenous urography were normal. Preoperative diagnosis was urachus-derived adenoma with the possibility of adenocarcinoma. At operation a typical urachus and--surprisingly--an appendico-vesical fistula was found.

A combination of the following malformations in a boy of 6 months is described: a salt-losing form of the adrenogenital syndrome, true hermaphroditism (external genitalia of the male type, the Fallopian and tissue of the embryonal ovary found in the abdominal cavity), left-side uretherohydronephrosis and microgyria of the right parietooccipital area of the brain.

Based on reports of 9 surgically proven cases, the authors stress the contribution of high-resolution sonography in the work-up of omphalovesical midline anomalies in children. Sonography (US) proved useful, especially in disorders of urachal patency (cystic mass and sinus type of the malformation). In the cystic-type mass (3 cases), a midabdominal echogenic cystic mass was demonstrated. The echogenic content resulted from infectious complication. In the sinus type, an echogenic, thickened, tubular omphalovesical tract (8-15 mm) was visualized. This tubular configuration results from the normal omphalovesical anatomy, as can be demonstrated by high-resolution US. With infection, the fascia surrounding the urachal remnants seems to limit the infection. Differential diagnosis should include vesical duplications anomalies, dystrophic calcifications of the umbilical arteries remnants, and, in case of a solid mass, urachal carcinoma. Ultrasound should be part of the work-up of any suspected urachal or other midline anomaly.

A case of urachal hamartoma occurred in the urinary bladder of a 45-year-old woman, whose presenting symptoms were frequent urination and nocturia. Computed tomographic and contrast radiologic examinations demonstrated a broad-based 5-cm polypoid mass at the dome of the bladder. Grossly the polypoid mass was smooth surfaced and covered by innocent transitional epithelium. The mass and the underlying bladder wall consisted of multiple cystic cavities of various sizes and hyperplastic smooth-muscle bundles. Light microscopy identified numerous tubuloglandular structures, most of them lined by transitional cell epithelium. Simple or ciliated columnar cells and occasional mucous cells were also present, particularly in the epithelium of cystic cavities. Some tubules had communicated with the bladder lumen. Hamartoma of the urachal remnant should be included in the differential diagnosis of urachal and bladder tumors.

26 cases of urachus anomalies are reviewed. Embryological, clinical and therapeutic problems are discussed. The authors point out the importance of a systematic urinary tract evaluation. Relationship between urachus anomalies and "prunebelly" syndrome is considered.

We report a patient with urachal transitional cell carcinoma invading the sigmoid colon. The diagnostic and therapeutic aspects of this disease are discussed. The literature is also reviewed. This 42-year-old man was admitted with the chief complaint of micturition pain. Operation consisting of total cystourethrectomy, excision of the urachus together with the umbilicus, pelvic lymphadenectomy, ilial conduit plasty, sigmoidectomy, and colorectostomy was performed on June 3, 1986, after the diagnosis of urachal carcinoma invading the sigmoid colon. A tumor the size of a hen's egg was found at the dome of the bladder extending to the sigmoid colon. The urachus 8 cm in length and 2 cm in diameter extended from the site of the tumor to the umbilicus. Histologically the tumor was a transitional cell carcinoma Grade III. The urachus was composed of epithelioid and muscle layers, and its lower end was filled with necrotic inflammatory debris so that the canal was obliterated; tumor cells infiltrated the muscle layer. No metastasis was found in lymphnodes. Combination therapy of 5 fluorouracil, adriamycin and cis-platinum was given after operation. He has returned to work and is doing well without evidence of metastasis or recurrence now at 1 year after the operation.

A report is presented of 5 cases of urachal carcinomas (3 women and 2 men). The mucous adenocarcinomas were located on the apex of the urinary bladder. In 3 cases partial cystectomy and in 2 cases a subtotal cystectomy were performed. Two patients were treated with cytostatics postoperatively. The prognosis of urachal carcinomas is poor. 3 patients had metastases to the bones, cerebrum and peritoneum. Diagnostic and therapeutic procedures are discussed.

Two cases of carcinoma of the urachus are reported, 1 involving the dome of the bladder and 1 occurring beneath the peritoneum of the anterior abdominal wall below the umbilicus at the apex of an elongated bladder. Both patients died shortly after diagnosis, a fact which emphasizes the poor prognosis of this group of patients. The poor prognosis and need for more than local resection of the tumour may not be widely appreciated. Tumours arising above the bladder have a different mode of presentation from those arising within the bladder wall. Bladder wall tumours are most frequently mucus-secreting adenocarcinomas; tumours arising above the bladder may be more variable in their histological type, and include squamous and undifferentiated cancer. A simple classification into vesicle and supra-vesical tumours is proposed, to replace an early classification into 7 groups.

We studied the structure and histologic appearance of intramural tubular urachal remnants in bladders from an unselected series of 122 autopsies, in which the patient age at death was 38 to 91 years. The bladders were fixed with formaldehyde introduced 10 minutes to 5 hours post mortem. Of the bladders 32 per cent showed tubular urachal remnants. The remnants were classified into 3 types on the basis of the epithelial extent and structure. Of the remnants 68.4 per cent had lumen covered with transitional epithelium, while the remainder had columnar epithelium. Bud-like epithelial proliferations were found in 43.6 per cent and mild dysplasia of the epithelium was found in 7.7 per cent of the urachal remnants, while mild inflammation in the loose peritubular tissue was demonstrated in 23.1 per cent.

Urachal cancers are uncommon malignancies with a location that often permits considerable local extension before they are discovered. The most common histological type is adenocarcinoma, which may produce mucus that is a valuable aid in diagnosis. The presence of stippled calcification in a midline abdominal wall mass is almost pathognomonic for urachal carcinoma. More commonly, however, the symptoms are less specific, such as hematuria and an abdominal mass. Many lesions are visible endoscopically and, thus, the diagnosis can be made preoperatively from a biopsy. Most treatment failures occur because the tumor is not controlled locally by the initial operation and, therefore, we recommend en bloc cystectomy with umbilectomy and pelvic lymphadenectomy unless the tumor is known to be a sarcoma or early stage (I) carcinoma. If these patients are undertreated and there is a local recurrence then the patient usually is not salvageable. Because of the difficulty in identifying the origin of a bladder adenocarcinoma, any tumor on the dome or anterior wall should be approached initially as if it were a urachal tumor.

A case of mucin-producing adenocarcinoma of the urachus is reported. Preoperative diagnosis was established by computerized axial tomography. The embryology, histogenesis, signs, symptoms, diagnostic criteria and treatment are discussed.

The authors report on two rare case urachal residue disease of late onset. They define the pathogenic factors contributing to the disease and describe the semeiological and radiological methods used in diagnosing the condition.

The urachus is an embryological structure originating from the allantois and situated in Retzius' space. Neoplasms originating from the urachus are very rare. They become clinically manifest late in the course of the disease. Deformation of the apex of the bladder and supravesical calcifications are described as radiological findings but these are of limited diagnostic value and should be supplemented by ultrasonic scanning, computed tomography and possibly by magnetic resonance scanning which will provide information about the extent of the disease. The final diagnosis is based on the macroscopic findings and the macroscopic picture. Three cases representing various aspects of the disease are presented. Treatment consists of en bloc resection in the form of partial cystectomy and excision of the tissue in Retzius' space and the umbilicus. The results are, however, disappointing as the five-year survival rates in the majority of materials do not exceed 10%. Irradiation is of doubtful value and chemotherapy is scarcely of value in the treatment.

We report a case of urachal carcinoma with elevated serum carcinoembryonic antigen (CEA) level in a 36-year-old man. En bloc resection was performed. The production of CEA was proved histologically. The level of serum CEA returned to the normal value after operation. Seventeen postoperative months the level of serum CEA was noted to be elevated again, and 2 months later symptoms appeared and tumor recurrence was revealed on computer tomographic scan. Radiotherapy and chemotherapy were done without any noticeable response. He died of tumor progression. In our case, serum CEA gave useful information as a tumor marker. It showed specificity for the tumor and helped evaluation of tumor resection as well as detection of tumor recurrence.

Reviewing 5 recent cases, different anatomical and clinical forms of partial or complete urachal persistency are described: patent urachus, urachal cyst, urachal sinus and urachal diverticulum. The risk of late malignant evolution of this embryonic vestige justifies radical surgical removal at time of diagnosis.

Malignant tumours of the urachus are very rare and they give certain difficulty in their differential diagnosis with vesical cupula adenocarcinoma. We present a case of mucinous adenocarcinoma of the urachus in a 75-year-old patient and we analyse the behaviour, clinical background, diagnosis and treatment of these tumours.

A case of actinomycosis of lower abdominal wall and bladder apex related to and involving urachal remnants is reported. The elderly patient presented with the not uncommon problem of a lower abdominal mass and vague sympatomatology but, in this case, of rare aetiology.

The umbilical cord is the lifeline of the fetus and of the neonate in the first few minutes after birth. Care of the cord and stump in the immediate neonatal period varies according to social, cultural, economic, and geographic factors. Measures taken to insure sterility in cutting, tying, and painting the umbilical cord may prevent serious diseases such as tetanus neonatorum. Care of the umbilical cord may be less than optimal in babies born at home in unsupervised "home delivery." Minor congenital anomalies of the umbilical cord, such as umbilical hernia, and major anomalies, such as gastroschisis and omphalocele, are reviewed in this article. Survival in babies with major anomalies of the cord has been improving steadily because of early diagnosis (including prenatal diagnosis), better operative procedures, and better understanding of the fluid and nutritional requirements of the neonate postoperatively. Diseases of the cord include omphalitis and, rarely, tumors.

Supravesical calcification noted on conventional radiography when associated with a bladder lesion has been considered nearly pathognomonic of the uncommon lesion, urachal adenocarcinoma. As the case reported here demonstrates, stippled microscopic calcification undetected by conventional means can be demonstrated uniquely by computed tomography with great sensitivity. Because urachal adenocarcinoma may be managed in a distinctly different manner if adequate preoperative preparation is made, it is suggested that in cases of anterior bladder lesions, computed tomographic imaging can detect this typical characteristic of urachal adenocarcinoma and may thereby provide further comfirmatory diagnostic evidence helpful in surgical planning.

A rare case of squamous cell carcinoma (SCC) is reported. A cystic tumor, measuring 4 X 4 cm was surgically removed from the supravesical portion in a 77-year-old woman. Macroscopically, it had a communicating canal to the urinary bladder. Microscopically, well differentiated squamous cell carcinoma with pearl formation was noted. An aspiration biopsy was helpful for the histopathological diagnosis at operation. The patient developed purulent peritonitis because of rupture of the tumor which was vulnerable to infection. Six documented cases and the present case were reviewed. The tumors were classified into two types on morphological features: supravesical type and intramural type. Site and local extension of the tumor accounted for clinical features of each type. The authors considered that SCC cells were derived from totipotential epithelial lining of the urachal remnant.