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The third documented case of primary squamous cell carcinoma of the urachus in the English literature is reported. The interesting coincidental occurrence of the dermoid cyst of the right ovary and a complete longitudinal septum of the vagina and uterine cervix is described.

Four cases of urachal carcinoma are presented. The first case was a 36-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiation therapy were performed. Histological findings showed a well differentiated adenocarcinoma. He has been well for twelve years postoperatively. The second case was a 52-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiochemotherapy were performed. Histological findings showed a moderately differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The third case was 70-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed multiple tumors at the dome of the bladder, internal urethral orifice and right lateral wall. Total cystectomy, ureterocutaneostomy and postoperative chemotherapy were performed. Histological findings showed a poorly differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The fourth case was a 68-year-old woman who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. CT scan demonstrated a mass with calcification extending from the bladder dome superiorly. Partial cystectomy and postoperative chemotherapy were performed. Histological findings showed a well differentiated adenocarcinoma. She has been well for three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma of urachal origin is a special type of primary vesical adenocarcinoma. Because of the anatomic and histologic character of this tumour the therapy is different from that of transitional carcinomas. Diagnostic modalities including ultrasonography and computed tomography are demonstrated. The findings are compared with those of an ovarial carcinoma metastasis also located in the bladder dome.

Urachal adenocarcinoma, normal urachus, and urinary bladder were studied by histochemical methods and electron microscopy. Many argyrophil cells were found in urachal adenocarcinoma and urachal epithelium. Autofluorescence and immunoperoxidase examinations showed that the argyrophil cells possessed serotonin, glucagon, and secretin. Some of the carcinoma cells and urachal epithelial cells contained fairly large amount of mucosubstances. On the other hand, only a few argyrophil cells and very weakly PAS positive cells were observed in the urinary bladder mucosa. This study showed that there were close similarities in the histochemical and electron microscopical features between the urachal carcinoma and urachal epithelium, and suggested that the undifferentiated stem cells were able to differentiate to both glandular and endocrine cells.

Signet ring cell adenocarcinoma of the bladder is rare. Only 16 cases are recorded in the literature, although two meet the requirements for being considered of urachal origin. We present the third case of signet cell adenocarcinoma of urachal origin.

Asymptomatic microscopic urachal remnants located at the vertex of the urinary bladder are common in cats. Because they reduce the tensile strength of the bladder wall at this location, they represent risk factors for development of acquired macroscopic diverticula in cats with lower urinary tract disorders. Elimination of the underlying cause of lower urinary tract disease is frequently associated with resolution of acquired macroscopic vesicourachal diverticula.

During the last 50 years 8 patients with adenocarcinoma of the urachus were managed at our hospital. The various modalities of therapy included radiation therapy, transurethral resection, segmental resection of the bladder and total cystectomy. A retrospective analysis of these cases is presented, including the histologic patterns, sites of spread and survival according to therapy.

An infected urachal cyst classically presents with a tender lower midline abdominal mass and systemic signs of infection, including fever, malaise, and leukocytosis. At times, the findings may be clinically confused with those of acute appendicitis, Meckel's diverticulitis, or peritonitis. Sonography aids in differentiating these entities by identifying the localized cystic mass containing debris, located anteriorly in the low mid-abdomen, extending from the region of the bladder to the umbilicus. We present an unusual case of an infected urachal cyst in a 6-year-old boy who presented with lower abdominal pain, fever, intermittent diarrhea, polyuria and dysuria, a firm, fixed left lower quadrant tender mass, and an elevated white blood cell count.

After 2 years of mucusuria a villous adenoma of the urachus was resected from a woman by partial cystectomy and excision of the entire urachus. Convalescence was uneventful and the patient was well 12 months later. Urachal adenomas are rare, this being the sixteenth case reported. Generally, they are multilocular cystic tumors lined by columnar epithelium with a population of mucous goblet cells. Often, there is a striking resemblance to gut epithelium. Ultrastructurally, by transmission and scanning electron microscopy, the tissue resembles gut mucosa. Urinary mucus is a common and relatively specific symptom for adenomas of the lower urachus, occurring in 7 of 11 cases. Resection alone is effective therapy but care must be exercised to avoid spilling adenoma cells in the peritoneum.

We describe a primary mixed adenocarcinoma-neuroendocrine carcinoma of the urinary bladder of probable urachal origin. Neuroendocrine differentiation was confirmed by ultrastructural (neurosecretory granules) and immunohistochemical studies (chromogranin and neuron-specific enolase). Two local recurrences and multiple metastases consisted exclusively of the neuroendocrine component. The patient died 30 months after diagnosis with widely metastatic neuroendocrine carcinoma.

A 71-year-old man was admitted with the chief complaint of gross hematuria. Cystoscopic examination showed a broadbased papillary tumor at the apex of the bladder. There was edema of the mucous membrane around the tumor. CT-scan demonstrated a mass extending from the bladder dome superiorly. Partial resection of the bladder was done. Pathological examination revealed grade 3 transitional cell carcinoma, with scattered adenocarcinoma and squamous cell carcinoma foci. Chemotherapy with bleomycin (BLM) and cis-dichlorodiamine platinum (CDDP) was done postoperatively. Ten months after the operation, he was readmitted because of recurrence in retroperitoneal lymph nodes. Chemotherapy with BLM and CDDP was done, but he died of pulmonary complications. Autopsy revealed retroperitoneal lymph node metastasis of transitional cell carcinoma. There was no metastasis to any other organ. We briefly discuss 275 cases of the carcinoma of the urachus collected from the Japanese literature.

The mesourachus is an uncommon anomaly in which the urachal remnant is connected with the anterior abdominal wall by a well-defined mesentery. Likewise, large-bowel obstruction secondary to adhesions and/or congenital bands is very rare in both adults and children. In the following case report of an 8-year-old boy with trisomy 13 syndrome and known intestinal malrotation, a segment of the mesourachus was bound by adhesions to the small-bowel mesentery. This arrangement resulted in severe obstruction of the descending colon, simulating a volvulus.

Urachal abnormalities may provoke especially urinary tract infections. They become symptomatically first of all in the childhood. The development of urachal carcinoma is particularly described in the adult. The features of diagnosis and treatment will be presented with clinical examples. The only possible treatment of those malformations is the operative removal of the urachal tissue. This is most important to prevent as well urinary tract infections as the malignant degeneration of the urachal malformations.

The authors observed 7 patients aged from 19 to 74. Five of them were operated upon. One patient died from anaerobic neclostridial phlegmon of the anterior abdominal wall which appeared after an injury of the not noticed urinary duct. Laparotomic accesses passing aside form the area of possible localization of the urinary duct were more justified. When operating on the paraumbilical area it is expedient to make a revision for the detection of the urachus and associated abnormalities on the anterior abdominal wall.