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Abstract Background Urachal carcinoma is an extremely rare malignant tumor originating from the urachus. Urachal adenocarcinoma has never been reported in patients under 20 years of age. In this case, we describe a 15-year-old patient with urachal adenocarcinoma and propose possible risk factors. Case presentation The patient presented with hematuria for two months and dysuria for one month, and had a history of smoking and alcohol consumption for three years. Ultrasonography showed an irregular mass on the anterior wall of the bladder. Contrast-enhanced computed tomography revealed a pedicled soft tissue mass measuring 2.6×2.4 cm within the bladder, showing significant enhancement. Partial cystectomy was conducted, and a histopathological diagnosis of urachal adenocarcinoma (T2N0M0) was made. During eight months of follow-up, the patient remained asymptomatic with no evidence of recurrence. Conclusions Urachal remnants may lead to urinary symptoms and the development of urachal carcinoma. A history of smoking and alcohol consumption could be possible risk factors for urachal adenocarcinoma in this case. It is possible that urachal remnants can undergo malignant transformation, even at ages as young as 15 years. Regular follow-up should be recommended for patients whose urachal remnants persist beyond childhood.

Abstract Neuroendocrine carcinoma arising from the urachus is extremely rare. We describe a case of a 33-year-old gentleman who presented with hematuria and diagnosed to have a composite adenocarcinoma and small cell neuroendocrine carcinoma arising from the urachus. The patient also had widespread metastasis at the time of presentation, therefore, he was referred for chemotherapy. However, the disease showed progression despite treatment. Recognition of neuroendocrine carcinoma component in urachal tumors, although rare, is very essential as this histologic type carries poor prognosis with aggressive clinical outcome.

The article presents the clinical observation of a patient born in 1965, who was examined and treated at the Russian Scientific Center of Roentgenoradiology for tumor of anterior bladder wall detected in May 2023 according to the results of radiation diagnostic methods (ultrasound, computed tomography, magnetic resonance imaging). Analysis of biopsy material obtained during cystoscopy revealed a highly differentiated mucinous urachal adenocarcinoma. Based on the diagnosis of malignant neoplasm of primary urinary tract (urachus) pT3N0M0 stage II, the surgical treatment was proposed. In June 2023, the Bricker procedure was performed: laparoscopic anterior pelvic exenteration with formation of intestinal reservoir. Control examination 3 months after showed no progression of the disease. Asymptomatic development of urachal carcinoma in early stages, peculiarities of its location in pelvic cavity and propensity to metastasis, as well as the rarity of such neoplasm indicate the need for earlier and more accurate verification of the diagnosis. This clinical case demonstrates characteristic clinical and imaging features of urachal adenocarcinoma, which may help radiologists, oncologists, and urologists in making diagnosis and choosing correct treatment tactics.

The urachus is a vestigial tubular structure extending from the bladder's anterior surface to the umbilicus, formed during embryonic development. Normally, it obliterates to form the median umbilical ligament; however, in some cases, remnants persist, leading to urachal anomalies such as fistulas, cysts, and diverticula. Urachal anomalies can result in complications, including infections and neoplasms, with malignant urachal adenocarcinoma being rare but more common than benign neoplasms. This cancer typically affects men aged 40-70, with symptoms like hematuria, abdominal pain, and palpable masses. Due to its extraperitoneal location, urachal carcinoma is often asymptomatic until advanced stages. Diagnosis of urachal carcinoma involves cystoscopy, imaging modalities like CT and MRI, and serum markers. Imaging plays a key role in detecting midline masses, often containing both solid and cystic components. CT and MRI can evaluate tumor extent and local invasion, but further assessment, such as biopsy, is often required. Surgical resection remains the primary treatment, with partial or radical cystectomy providing comparable outcomes. Despite advances in chemotherapy and immunotherapy, prognosis remains poor, with a 5-year survival rate of around 50%, particularly in cases with lymph node involvement or metastasis. [ABSTRACT FROM AUTHOR]

Background: Uroperitoneum is a typical disease of the newborn foal, which occurs rarely but regularly. Ultrasonography is considered the most important imaging method for diagnosing this disease. Thus far, only one older case series comprising 31 foals suffering from uroperitoneum has systematically listed results of ultrasound examinations. Objective: This paper presents the findings of an ultrasonographic examination of 34 foals with uroperitoneum in order to inform future interpretation of ultrasonographic data in suspected uroperitoneum cases. Method: Ultrasonographic data of 34 neonatal foals up to the age of 14 days diagnosed with uroperitoneum between 2006 and 2022 were analysed. Results: Most foals demonstrated highly increased levels of free (97%), anechogenic (91%) fluid in the abdomen. Although the urinary bladder was frequently visible (50%), bladder wall discontinuity was only occasionally detectable (18%). Conclusion: Transabdominal ultrasonography has proved to be a very reliable imaging method for diagnosing suspected uroperitoneum. It is recommended that it be used in every case of suspected uroperitoneum in order to exclude differential diagnoses. [ABSTRACT FROM AUTHOR]

Neuroendocrine carcinoma arising from the urachus is extremely rare. We describe a case of a 33-year-old gentleman who presented with hematuria and diagnosed to have a composite adenocarcinoma and small cell neuroendocrine carcinoma arising from the urachus. The patient also had widespread metastasis at the time of presentation, therefore, he was referred for chemotherapy. However, the disease showed progression despite treatment. Recognition of neuroendocrine carcinoma component in urachal tumors, although rare, is very essential as this histologic type carries poor prognosis with aggressive clinical outcome. [ABSTRACT FROM AUTHOR]

Over the years, an anomaly has been observed in newborn lambs, manifesting itself as a curvature in their posture and a slight dampness in the navel, known by the locals as "pupote". For this reason, the present study was carried out to document and present for the first time to the scientific community an anomaly of the urachus in sheep and its incidence. In the sampling process, five lambs who died of starvation were selected. The specimens were transported to the Animal Health Laboratory of the Faculty of Zootechnics of the National University of Central Peru. Radiographic analyses were carried out there. Then the incidence was found in the collected records. The incidence of the anomaly is an average of 0.825±0.09%. This case highlights the persistence of urachus in newborn lambs, evidenced by the identification of a ligament that establishes a connection between the umbilicus and the liver. Specifically, the ligament identified in the described anomalies corresponds to the ligamentum teres. [ABSTRACT FROM AUTHOR]

Background: Urachal carcinoma is an extremely rare malignant tumor originating from the urachus. Urachal adenocarcinoma has never been reported in patients under 20 years of age. In this case, we describe a 15-year-old patient with urachal adenocarcinoma and propose possible risk factors. Case presentation: The patient presented with hematuria for two months and dysuria for one month, and had a history of smoking and alcohol consumption for three years. Ultrasonography showed an irregular mass on the anterior wall of the bladder. Contrast-enhanced computed tomography revealed a pedicled soft tissue mass measuring 2.6×2.4 cm within the bladder, showing significant enhancement. Partial cystectomy was conducted, and a histopathological diagnosis of urachal adenocarcinoma (T2N0M0) was made. During eight months of follow-up, the patient remained asymptomatic with no evidence of recurrence. Conclusions: Urachal remnants may lead to urinary symptoms and the development of urachal carcinoma. A history of smoking and alcohol consumption could be possible risk factors for urachal adenocarcinoma in this case. It is possible that urachal remnants can undergo malignant transformation, even at ages as young as 15 years. Regular follow-up should be recommended for patients whose urachal remnants persist beyond childhood. [ABSTRACT FROM AUTHOR]

Background: Urachal tumors are rare in clinical practice, among which urachal adenocarcinoma is the most common. In this study, we report a rare case of urachal perivascular epithelioid cell tumor to improve our understanding of the disease. Case presentation: A 26-year-old male patient was hospitalized for lower abdominal pain. The US showed a hypoechoic mass measuring 26mm x 18mm in the superior aspect of the bladder. MRI showed an irregular mass located anterior to the bladder roof, near the midline. The tumor exhibited hypointense on T1WI and heterogeneous hyperintense on T2WI. Additionally, contrast-enhanced T1-weighted imaging revealed obvious ring enhancement of the tumor. The patient underwent surgical resection of the urachal tumor, with subsequent pathological examination revealing a diagnosis of urachal PEComa. Following surgery, the patient underwent regular follow-up assessments, with no evidence of recurrence or metastasis observed after three and a half years. Conclusions: Urachal PEComa is a rare mesenchymal tumor that presents challenges in diagnosis through imaging and clinical symptoms. Definitive diagnosis relies on pathological and immunohistochemical analysis. Due to the rarity of urachal PEComa, prognosis assessment necessitates long-term follow-up and evaluation of more cases. [ABSTRACT FROM AUTHOR]

We present a case of a young patient with a symptomatic urachal carcinoma. The patient underwent surgical resection at our department and is now in remission. Urachal cancer must be considered when examining a patient with visible hematuria. [ABSTRACT FROM AUTHOR]

Objectives -- The objective of the study was to analyze clinical, laboratory and ultrasound imaging features of newborns with acute omphalitis (AO) and to define the most common congenital urachal anomalies that can present as neonatal AO and be diagnosed with umbilical ultrasound (US) imaging. Patients and Methods -- The study included newborns aged up to 44 postconceptional weeks with AO and congenital urachal anomalies (persistent patent urachus, urachal cyst, diverticulum and sinus). Results -- The study included 226 newborns, 132 (58.4%) male and 12 (5.3%) preterm. Their mean age was 9.7 days. The most frequent local signs of AO were umbilical discharge (151, 66.8%), periumbilical erythema (120, 53.1%) and periumbilical edema (64, 28.3%). The most frequently isolated bacteria, alone or in combination with other bacteria, was Staphylococcus aureus (120 newborns, 73.2%). Antibiotic treatment was needed in 148 (65.5%) newborns; most frequently intravenous flucloxacillin and gentamicin. US examination of the umbilical region was performed in 164 (72.6%) newborns with AO and congenital urachal anomalies were found in 96 (58.5%) newborns. The most frequent pathology was persistent patent urachus, found in 84 (87.5%) newborns. Conclusions -- AO, one of the most common infections in the neonatal period, could be causally related to congenital urachal anomalies, especially persistent patent urachus, in more than half of cases. US imaging of the umbilical region represents the diagnostic modality of choice for detecting underlying urachal pathology. [ABSTRACT FROM AUTHOR]

Urachal cancer is a rare malignancy of the urachus that is treated with surgical resection if localized and systemic chemotherapy for metastatic disease. Circulating tumor DNA (ctDNA) is a single-stranded or double-stranded DNA released by tumor cells into the blood and harbored the mutations of the original tumor, shedding new light on molecular diagnosis and monitoring of cancer. We report a case of resected localized urachal cancer with clear surgical margins and negative lymph node dissection but elevated ctDNA that progressed to metastatic disease. We also highlight the possibility of using ctDNA levels to assist in adjuvant therapy. [ABSTRACT FROM AUTHOR]

Abstract Neoplasms originating from the urachus are exceptionally uncommon, comprising only 0.17% of all bladder neoplasms. Among these, the mucinous cystic tumor of low malignant potential (MCTLMP) is particularly rare, with only 25 documented cases in medical literature. Despite their rarity, it is essential to identify MCTLMPs given the possibility of severe complications. Fortunately, surgical removal offers promising cure rates. In this report, A 40-year-old female patient presented to the hospital with abdominal pain. Subsequently, a CT scan showed a 9-cm cystic mass pressing the bladder. The lesion was surgically excised and histopathological examination was performed. Grossly, the specimen consisted of a cyst with a smooth external surface and mucinous content. Microscopically, the cyst was lined by columnar mucinous epithelial cells that included basally-located hyperchromatic nuclei and scattered Goblet cells consistent with an intestinal phenotype. The epithelial cells show mild atypia with focal papillary formations and flattening due to compression. Immunohistochemically, the epithelial tumor cells expressed cytokeratin 20, CDX2, beta-catenin (membranous); and were negative for cytokeratin 7. The location, histopathological, and immunohistochemical findings were consistent with a diagnosis of MCTLMP. In this report, we present an instance of urachal MCTLMP, which represents less than 30 cases documented in the medical literature. This case study marks the importance of early identification of MCTLMP due to their potential for severe complications, despite the tumor’s low malignant potential and to exclude more aggressive tumors with areas of intraepithelial or invasive carcinoma.

Abdominal pain is a common presenting complaint in a primary care setting. Umbilical discharge secondary to umbilical anomalies is usually diagnosed in children and is rare in adults. This case highlights the possibilities of umbilical anomalies as causes of undifferentiated abdominal pain and umbilical discharge in adults. A 24-year-old male presented with a recurrent history of undifferentiated lower abdominal pain and umbilical discharge but was not diagnosed appropriately, leading to multiple visits to general practitioners and emergency departments for four years. An abdominal ultrasound was done, which revealed a hypoechoic tubular structure at the midline of the abdomen. A diagnosis of patent urachus was made and he was then referred to the surgical team for excision of the patent urachus. [ABSTRACT FROM AUTHOR]

Abstract Background A urachal mass is a relatively rare presentation to the urologists’ practice, often requiring radical surgical excision for a definitive diagnosis. Xanthogranulomatous inflammation of the urachus is an extremely rare entity with few cases reported worldwide, and to the best of our knowledge, no cases reported in the western world. Case presentation In this case, a 55-year-old male patient presented with bothersome lower urinary tract symptoms and computed tomography findings demonstrating a urachal mass that was worrisome for urachal carcinoma. Following surgical intervention, histopathology revealed urachal xanthogranuloma. Post-operatively, the patient recovered well, and eventually, he had symptomatic and radiologic improvement. Conclusion This case brings awareness to a rare presentation of a urachal mass—urachal xanthogranuloma. While operative intervention was both diagnostic and therapeutic, we highlight the challenge in differentiating between benign and malignant processes for urachal masses. Herein, we show the importance of including urachal xanthogranuloma in the differential diagnosis of a urachal mass to prevent further morbidity associated with the treatment of this disease.

Background: The urachus is a fibrous cord that arises from the anterior bladder wall and extends to the umbilicus, degenerating after birth [1]. Urachal cysts are congenital abnormalities resulting from incomplete obliteration of the urachus into the median umbilical ligament [2–4]. The cyst often remains asymptomatic but can present with symptoms associated with urinary tract infection, abdominal pain, erythema, swelling, and hematuria [5]. When left untreated, can lead to severe complications like rupture and sepsis [6]. Definitive treatment is with excision, which can be performed via an open, laparoscopic, and robotic approach. Objective: To present a video case report of robotic-assisted excision of a urachal cyst, highlighting key takeaways for robotic surgical trainees. Methods and Materials: We report a 24-year-old previously healthy male who presents with umbilical pain for one week and drainage from the umbilicus for one day. He had a similar episode ten years ago which self-resolved within a day. CT abdomen/pelvis with contrast notable for a 1.8 cm rim-enhancing fluid collection deep to the umbilicus. Patient was treated with a course of Bactrim with resolution of his symptoms and interval imaging notable for resolution of fluid collection. Patient decided to proceed with robotic-assisted excision of urachal cyst due to recurrent infections and drainage. Results: Intra-operatively, the urachal cyst was identified and skeletonized to the level of the umbilicus and then down to the level of the bladder. The cyst was excised with a circumferential margin, and the resulting bladder defect that was closed in two layers. After the bladder was filled demonstrating no leak, the urachal cyst was removed without complication. Conclusions: Urachal cysts are a congenital anomaly that can present with a wide variety of clinical presentations [7,8]. Robot-assisted removal provides a minimally invasive technique for successful excision of a urachal cyst when indicated.

BACKGROUND: Paraneoplastic glomerulopathies are a scarce manifestation of oncologic diseases. Tumors frequently associated with kidney disease include gastrointestinal neoplasms and lung carcinomas. The most commonly subtypes in men are extracapillary, membranous and mesangiocapillary nephropathy, and minimal change disease in women. CLINICAL CASE: A 40-year-old male patient in which a rapidly progressive focal and segmental glomerulosclerosis associated with urachal adenocarcinoma was found during haematuria approach. CONCLUSIONS: Nowadays no study has been able to determine the true incidence of glomerular impairment in cancer, but a link has been identified between several particular glomerulopathies and specific cancers. [ABSTRACT FROM AUTHOR]

The urachus is a tubular structure that is apparent on the third week and connects the ventral cloaca to the yolk sac, as a progression from the allantois. Following the normal regression procedure, the urachus remains as the median umbilical ligament. Urachal remnants are present in 1.03% of paediatric patients while in 92.5% of cases represent incidental findings. Urachal anomalies are classified in four types as patent urachus (50-52%), urachal sinus (15%), urachal cyst (30%) and urachal diverticulum (3-5%). Ultrasound scan is the most commonly performed diagnostic imaging study. In case of symptomatic urachal remnants, surgical excision is indicated. Asymptomatic urachal remnants that are diagnosed at the neonatal period or early infancy should be watched up to 6 months of age, as they are likely to resolve. In persistent or symptomatic urachal remnants there is a risk of inflammation or even malignancy development, therefore we believe that there is indication for preventive surgical excision that may be performed either open or laparoscopically or by robot-assisted laparoscopy. [ABSTRACT FROM AUTHOR]

Urachal adenocarcinoma is one of the rare and aggressive neoplasms that often presents at an advanced stage and has a poor prognosis. Urachal adenocarcinoma makes up 0.17 to 0.34% of all bladder carcinomas. Patients commonly present with hematuria. Wide local excision of urachal mass with umbilicus and surrounding soft tissue en bloc combined with partial or radical cystectomy and bilateral pelvic lymphadenectomy is considered to be the primary surgical management. However, many publications in literature report that en bloc removal of tumor with umbilicus, entire urachal ligament, and bladder dome alone has long-term survival and disease-free period. Here, we present a case of a 50-year-old post-menopausal female patient with a fungating mass in the umbilical region of size approximately 10 cm in maximum diameter with mucopurulent discharge from the mass. The patient had no history of any hematuria, mucinuria, burning micturition, or any particles in urine. A laparotomy was performed, and tumor mass along with the cuff of the bladder dome was removed as en bloc along with umbilectomy. This case report highlights a rare case of urachal adenocarcinoma with a fungating mass of large size in a female patient which is otherwise more commonly seen in males. A review of published literature is also presented. [ABSTRACT FROM AUTHOR]

Background: Urachal tumors are exceedingly rare, and adenocarcinoma is the most common malignant urachal neoplasm. Here, an especially rare patient of primary urachal leiomyosarcoma from our hospital was reported, and only five patients have been reported thus far since 1981. Case description: A 24-year-old man was admitted due to urinary tract symptoms. Both urogenital ultrasonography and contrast-enhanced computed tomography showed a mass at the dome of the urinary bladder. Laparoscopic surgical resection was performed, and histopathologic examination of the mass confirmed the diagnosis of urachal leiomyosarcoma. No recurrence was noted after one and a half years. Conclusions: Because the leiomyosarcoma located in the extraperitoneal space of Retzius and may manifest with nonspecific abdominal or urinary symptoms, early and definitive preoperative diagnosis is challenging. Partial cystectomy with complete excision of the urachus is recommended. Because only a few patients have been recorded, clinical outcomes and recurrence risks are difficult to assess. [ABSTRACT FROM AUTHOR]

Background: A urachal mass is a relatively rare presentation to the urologists' practice, often requiring radical surgical excision for a definitive diagnosis. Xanthogranulomatous inflammation of the urachus is an extremely rare entity with few cases reported worldwide, and to the best of our knowledge, no cases reported in the western world. Case presentation: In this case, a 55-year-old male patient presented with bothersome lower urinary tract symptoms and computed tomography findings demonstrating a urachal mass that was worrisome for urachal carcinoma. Following surgical intervention, histopathology revealed urachal xanthogranuloma. Post-operatively, the patient recovered well, and eventually, he had symptomatic and radiologic improvement. Conclusion: This case brings awareness to a rare presentation of a urachal mass—urachal xanthogranuloma. While operative intervention was both diagnostic and therapeutic, we highlight the challenge in differentiating between benign and malignant processes for urachal masses. Herein, we show the importance of including urachal xanthogranuloma in the differential diagnosis of a urachal mass to prevent further morbidity associated with the treatment of this disease. [ABSTRACT FROM AUTHOR]

Accessory spleen (AS) refers to single or multiple splenic tissues which appear outside the relative normal spleen position results from embryonic dysplasia similar in structure and function to the spleen. AS is frequently observed in the splenic hilus and or adjacent to the tail of pancreas, and only a few cases occurred in the pelvic cavity. We present an extremely rare AS case in urachus, which was initially considered as an urachal neoplasm revealed on CT images with big mass. However, the postoperative pathology confirmed it was an AS that had not been reported at urachal before. Urachal AS can be misdiagnosed as a tumor, so it is vital to make an accurate imaging preoperative diagnosis to avoid unnecessary biopsy and surgery. [ABSTRACT FROM AUTHOR]

Background: The umbilicus is the fibrous remnant of the fetal attachment of the umbilical cord. Ultrasonography is the preferred imaging modality for the evaluation of umbilical lesions. We present our experience and a review of ultrasound findings of umbilical lesions in children that may differentiate these lesions.Methods: A query was conducted on online databases to identify and review articles in English studying umbilical lesions and their ultrasound features in children until September 2022. In some cases, the authors' unpublished experiences were also used due to insufficient ultrasound information in the literature.Results: The thickness of the normal urachus is 2.5- 4 mm in newborns, and after the infancy period, it reduces to less than 2 mm. An increase in its thickness, generally or focally, indicates a patent urachus or urachal sinus. The normal cord or its remnant is observed as a hypoechoic mass surrounded by an elevated skin ring during infancy. The abdominal extension of the cord remnant suggests a patent urachal or omphalomesenteric remnant. On ultrasound, umbilical polyps are deep-seated lesions with mixed or hyper-echoic echo texture that can help differentiate them from umbilical cord remnants or umbilical granulomas. Ultrasonographic findings of omphalitis or the infected cord remnant are enlarged umbilicus as a large mass-like lesion associated with edema of peri-umbilical skin and subcutaneous tissues.Conclusion: As evidenced by the results of this study, ultrasound can be used as a valuable complementary assessment tool for clinicians, allowing for assessing umbilical lesions and choosing the correct approach to treating these lesions. Keywords: Omphalomesenteric duct, Ultrasound, Umbilical lesion, Umbilicus, UrachusBackground: The umbilicus is the fibrous remnant of the fetal attachment of the umbilical cord. Ultrasonography is the preferred imaging modality for the evaluation of umbilical lesions. We present our experience and a review of ultrasound findings of umbilical lesions in children that may differentiate these lesions.Methods: A query was conducted on online databases to identify and review articles in English studying umbilical lesions and their ultrasound features in children until September 2022. In some cases, the authors' unpublished experiences were also used due to insufficient ultrasound information in the literature.Results: The thickness of the normal urachus is 2.5- 4 mm in newborns, and after the infancy period, it reduces to less than 2 mm. An increase in its thickness, generally or focally, indicates a patent urachus or urachal sinus. The normal cord or its remnant is observed as a hypoechoic mass surrounded by an elevated skin ring during infancy. The abdominal extension of the cord remnant suggests a patent urachal or omphalomesenteric remnant. On ultrasound, umbilical polyps are deep-seated lesions with mixed or hyper-echoic echo texture that can help differentiate them from umbilical cord remnants or umbilical granulomas. Ultrasonographic findings of omphalitis or the infected cord remnant are enlarged umbilicus as a large mass-like lesion associated with edema of peri-umbilical skin and subcutaneous tissues.Conclusion: As evidenced by the results of this study, ultrasound can be used as a valuable complementary assessment tool for clinicians, allowing for assessing umbilical lesions and choosing the correct approach to treating these lesions.

This is a case report about a patient presenting with a urachal mass mimicking a urachus adenocarcinoma. Cystoscopy showed a vesicourachal patent diverticulum. Histological findings after the removal of the umbilicus, urachus, urachal tumor, as well as a bladder cuff, consisted of a nonspecific polymorphous suppurative inflammatory infiltrate. Urachal adenocarcinoma is an aggressive tumor with poor prognosis if not treated while it is still localized. Surgical excision is the only recommended treatment that offers the best chances of survival. As no preoperative procedure has been proven accurate enough to rule out the diagnosis of adenocarcinoma, surgery appears to be inevitable.

A 52 year old woman presented to the emergency department of Affiliated Hospital of Zunyi Medical University in May 2022, complaining of a palpable lower abdominal mass since two days. She denied haematuria, umbilical drainage, or any other urinary symptoms. Previous physical health. Patient was diagnosed with urachal inflammatory pseudotumour. Inflammatory pseudotumourous masses of the urachal canal are rare chronic inflammatory disorders with only a few case reports. Ultrasonography is the preferred method for diagnosing urachal lesions. Contrast-enhanced ultrasonography (CEUS) allows real-time visualization of the microvascular blood flow within the solid lesion, reducing the probability of misdiagnosis of the disease. We have reported a case of urachal inflammatory pseudotumour and analyzed its ultrasonographic findings from two-dimensional conventional ultrasonography and CEUS to provide support for the diagnosis of urachal inflammatory pseudotumour in the clinic and to assist clinical selection of effective treatment modalities. Keywords: Urachus. Inflammatory pseudotumor. Ultrasonography. CEUS.

ABSTRACT: Background: The urachus is an embryonic remnant occurring as result of involution of the allantoic duct and the ventral cloaca. This canal becomes progressively obliterated after birth. It uncommonly persist as different variants after birth. Case presentation: One Frisian inbreeding young bull was presented at Al-Etgaan private clinic, Tripoli, Libya, with distended abdomen and clinical signs of chocking, with low grade fever, loss of appetite, frothy mouth, arched back, grinding, with clear distended left flank region with no ruminal movement sound. On the first time of inspection the suspected diagnosis was simple indigestion because of the same clinical sings the bull had. A stomach tube was introduced with little relief had showed on distension, but the animal vitally was in bad shape. Five days later surgical intervention has been done through laboratomy, a big balloon cyst like structure extended ventrolatrally was noted. The structure was located on the floor of the abdominal wall extending from pelvic rim caudally to umbilical region cranially. We deal with situation as it should be. The bull made an uneventful recovery. Conclusion: urachus is an urgent case that it needs instant diagnosis, a good treatment and a good prognosis would expect. Literature on the embryology and anatomic basis of such duct is discussed beside more detailed on the case will addressed in this report. [Open Vet J 2022; 12(5.000): 628-631]

Introduction Paragangliomas (PGLs) are frequently reported around the abdominal aorta; however, are extremely rare near the urachus. Case presentation A 78‐year‐old woman was referred to the urology department of our hospital for further examination and treatment of a 1.2‐cm tumor in the lower abdominal wall, a tumor excision was then performed. On immunohistochemical staining, the tumor and supporting cells were positive for chromogranin A and the S 100 protein, respectively, and were diagnosed as PGL. The PGL was thought to be derived from chromaffin cells that migrated to the wall of the urachus during embryonic life and remained even after the wall regressed. Conclusion We report a case of PGL near the urachus that can be explained by the distribution of the sympathetic network around the midline of the lower abdominal wall during embryonic development. Therefore, PGL should be considered in the differential diagnosis of periurachal tumors.

Background: An omphalocele is a common congenital abdominal wall defect, however co-occurring urological anomalies are rare. With the aim of optimizing treatment in future cases, we present a case of a male newborn with an omphalocele containing an unusual mucosal protruding mass, and give an overview of differential diagnosis and current literature. Case presentation: A newborn presented with an omphalocele containing small bowel, and a defect in the sac through which a protruding annular mucosal mass was visible. On previous prenatal ultrasounds, there were findings of an enlarged urinary bladder with patent urachus, communicating with a large allantoic cyst. The patient was taken to the operating room for exploration of the mucosal mass, which then appeared to be connected to an opening in the urinary bladder. The mucosal mass was successfully excised and the urinary bladder and abdominal wall defect were both primarily closed. Conclusions: Omphalocele with co-occurring urological anomalies are rare and come with a broad differential diagnosis. Surgeons must take prenatal, clinical and perioperative findings in consideration in order to adequately diagnose and treat the anomalies.

Twenty patients of urachal adenocarcinoma diagnosed at our institute presented with Mayo 1 to 3 stage in 90% of the cases. Median disease-free survival (DFS) was improved with the use of adjuvant chemotherapy. After a median follow-up of 26.5 months, the median overall survival (OS) after the diagnosis of metastasis was 13 months, while the median OS of the entire cohort was 42 months. Background: Urachal adenocarcinoma is a rare cancer of a urachal remnant with limited literature and a lack of randomized prospective studies. Materials and Methods: The data of urachal adenocarcinoma cases diagnosed at our institute from January 2013 to March 2021 were retrieved from the electronic medical records. Demographic data were presented using descriptive statistics and simple percentages; survival was calculated using the Kaplan-Meier method. Results: The median age of twenty patients included in the study was 46.5 years with an almost equal male-to-female distribution. Eighteen (90%) patients were diagnosed with Mayo stage 1 to 3 disease at presentation; all of these patients underwent surgical resection of the tumor, while only 8 patients received adjuvant chemotherapy. After a median followup of 26.5 months, treatment failure occurred in 7 (38.8%) patients at a median of 12 months. The median disease-free survival (DFS) was 14 (95% CI, 9.1-18.8) months for the 10 patients who did not receive adjuvant chemotherapy, while it was not reached for the 8 patients who received adjuvant chemotherapy. The median progression-free survival (PFS) for the 8 patients treated with palliative chemotherapy was 3 (95% CI, 0-9.5) months and the median overall survival (OS) after the diagnosis of metastasis was 13 (95% CI: 10.1-15.9) months. The median OS of the entire cohort was 42 (95% CI: 20.8-63.2) months. Conclusion: Urachal adenocarcinoma requires multimodality management with the incorporation of adjuvant chemotherapy to achieve favorable clinical outcomes. Further collaborative studies are required to improve survival in this rare cancer. [ABSTRACT FROM AUTHOR]

Background: The umbilicus is the fibrous remnant of the fetal attachment of the umbilical cord. Ultrasonography is the preferred imaging modality for the evaluation of umbilical lesions. We present our experience and a review of ultrasound findings of umbilical lesions in children that may differentiate these lesions. Methods: A query was conducted on online databases to identify and review articles in English studying umbilical lesions and their ultrasound features in children until September 2022. In some cases, the authors' unpublished experiences were also used due to insufficient ultrasound information in the literature. Results: The thickness of the normal urachus is 2.5- 4 mm in newborns, and after the infancy period, it reduces to less than 2 mm. An increase in its thickness, generally or focally, indicates a patent urachus or urachal sinus. The normal cord or its remnant is observed as a hypoechoic mass surrounded by an elevated skin ring during infancy. The abdominal extension of the cord remnant suggests a patent urachal or omphalomesenteric remnant. On ultrasound, umbilical polyps are deepseated lesions with mixed or hyper-echoic echo texture that can help differentiate them from umbilical cord remnants or umbilical granulomas. Ultrasonographic findings of omphalitis or the infected cord remnant are enlarged umbilicus as a large mass-like lesion associated with edema of peri-umbilical skin and subcutaneous tissues. Conclusion: As evidenced by the results of this study, ultrasound can be used as a valuable complementary assessment tool for clinicians, allowing for assessing umbilical lesions and choosing the correct approach to treating these lesions. [ABSTRACT FROM AUTHOR]

Background: Urachal carcinoma (UrC) is a rare, aggressive cancer with a poor prognosis that is frequently diagnosed in advanced stages. Due to its rarity, the current staging systems, namely Sheldon, Mayo, and Ontario were established based on relatively small patient cohorts, necessitating further validation. We used a large patient population from the National Cancer Database to model a novel staging system based on the Tumor (T), Node(N), and Metastasis (M) (TNM) staging system and compared it to established staging systems. Methods: We identified patients diagnosed with UrC between the years of 2004–2016. To determine median overall survival (OS), a Kaplan–Meier (KM) curve was generated using the Sheldon, Mayo, Ontario, and TNM staging system. A cox proportional‐hazards regression model was developed to highlight predictors of overall survival. Results: A total of 626 patients were included in the analysis. The OS for the entire cohort was 58.2 months (50.1–67.8) with survival rates at 12, 24, and 60 months of 83%, 70%, and 49%, respectively (p < 0.0001). As compared to the Sheldon, Mayo, and Ontario staging system, our TNM staging system had a more balanced sample and survival distribution per stage and no overlap among stages on KM survival curves. The Mayo, Ontario, and TNM staging systems were more accurate in terms of stage‐survival correlation than the Sheldon staging system (p < 0.05 for all stages). Conclusions: The proposed novel TNM staging system for UrC has a more balanced sample distribution and a more accurate stage‐survival correlation than the traditional Mayo, Sheldon, and Ontario staging systems. It is clinically applicable and enables better risk stratification, prognosis, and therapeutic decision‐making. [ABSTRACT FROM AUTHOR]

It is defective obliteration of the urachus that causes urachal cysts. Failure of urachus to involute can contribute to anomalies that may increase the risk of infection and/or malignancy if left untreated. A 29-year-old female with clinical features suggestive of acute abdominal pain is presented in this case report. Complete blood counts, serum electrolytes, urinalysis, renal function tests were normal. In the suprapubic region, an ultrasonographic examination revealed a hypoechoic lesion measuring 2 cm × 1.5 cm in size and contrast-enhanced CT scan confirmed a non-communicating urachal cyst between abdominal wall and urinary bladder's anterior wall. Urine culture revealed significant growth of Escherichia coli and was susceptible to eight out of fifteen antibiotics. The patient was successfully treated with parenteral amikacin. In clinical office, urachal cysts need to be diagnosed and managed promptly with a high degree of suspicion. Radiology, urine culture & sensitivity are effective strategies to curb the acute presentation of Urachal Cyst. [ABSTRACT FROM AUTHOR]

Urachal carcinoma (UrC) is a rare, nonurothelial malignancy, comprising less than 1% of all bladder cancers. It usually affects males in their fifth to sixth decade and is often diagnosed at an advanced stage with metastasis. This study examines UrC population characteristics and management. We identified UrC patients from bladder biopsies or TURB in the PearlDiver Mariner database (2010-2022). Descriptive statistics detailed patient characteristics. Student's T-Tests compared ages for partial vs. radical cystectomy, and Fisher's exact test compared SDOH presence. Significance was set at P <.05. Analyses used R version 3.6.0 within PearlDiver's software. Among 2475 UrC patients (mean age 69.2 ± 9.2 years, 73.1% men), most were in the south (36.5%), outpatient settings (84.5%), and privately insured (65.3%). A total of 418 (16.2%) had at least 1 SDOH. Imaging before diagnosis was used in 65.74% of patients, primarily ultrasound. Smoking was present in 54.5%, diabetes in 42.9%, and obesity in 25.2%. After diagnosis, 1246 (50.34%) had localized disease; 407 underwent radical cystectomy and 330 partial cystectomy. Patients undergoing radical cystectomy were older (66.74 ± 8.13 years) compared to those undergoing partial cystectomy (60.55 ± 12.92 years) (P <.001), with SDOH factors more prevalent in the partial cystectomy group (P =.03). UrC is a rare, often advanced-stage cancer predominantly affecting older men. Our study shows a trend towards partial cystectomy for localized UrC. Further research is needed to personalize surgery and integrate multidisciplinary approaches for better outcomes. Urachal carcinoma (UrC) is a rare malignancy often diagnosed at an advanced stage. In this study of 2,475 UrC patients, 50.34% had localized disease. Radical cystectomy patients were older (66.74 ± 8.13 years) compared to partial cystectomy patients (60.55 ± 12.92 years) (P <.001). There is a trend towards partial cystectomy for localized UrC. Further research is needed to personalize surgery and improve outcomes. [ABSTRACT FROM AUTHOR]

Urachal adenocarcinomas are rare cancers of the urinary bladder. Both CT and MRI are useful imaging modalities for the diagnosis and evaluation of urachal adenocarcinoma. Unlike CT or MR, there have been variable FDG PET findings with urachal tumours potentially due to considerable variation in their hypermetabolism. We present the case of a 24 year-old female patient who was diagnosed with urachal mucinous adenocarcinoma with characteristic features on CT and MRI which also exhibit moderately increased FDG avidity.

Abstract Background 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. Case presentation 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. Conclusions 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.

Objective:Urachal remnants are rare conditions in children with controversial management. Many of them present with complaints; however, the causality between the symptom and the condition is unclear, and a significant proportion of patients are incidentally identified. Meanwhile, indications of the surgical correction are controversial and the best way of surgical approach depends on the attending physician’s experience. This study aimed to evaluate the results of surgically corrected urachal conditions in children.Materials and Methods:This study included patients (n=21) who underwent surgery for urachal conditions between 2010 and 2020. Age, presenting symptoms, radiological evaluation, surgical approach, and results, and histological results are retrospectively evaluated.Results:Of the patients, 12 (57%) were boys, and abdominal pain was the most common presenting symptom (43%). The exact anomaly could not be classified in 8 patients, but classified as urachal sinus (n=5), urachal cyst (n=4), patent urachus (n=2), urachal diverticulum (n=1), and neuroblastoma (n=1) in the rest. Patients with umbilical discharge presented significantly younger than patients with abdominal pain or incidentally recognized patients (2.4±1.2, 7.2±1.17, and 10.9±3.1 years, respectively; p

Objective: The urachus is a remnant of the embryological allantois and usually regresses before birth. Persisting urachal abnormalities can lead to infection or even malignancy. Because malignant deterioration becomes more likely with age, resection is advised in adults. The spectrum of urachus neoplasms consists of benign to borderline benign mucinous cystic tumors, to low-grade malignant or malignant mucinous cystadenocarcinomata. There are several surgical procedures for dissection an urachus remnant. We performed a robot-assisted laparoscopic partial cystectomy with simultaneous cystoscopy for a lesion at the dome of the urinary bladder. Patient and surgical procedure: We present a case of a 59-year-old woman who was diagnosed with recurrent breast carcinoma. A staging PET-CT revealed a mass at the dome of the urinary bladder. We performed a robot-assisted laparoscopic partial cystectomy with cystoscopic guidance. The lesion was excised en-bloc with the median umbilical ligament. Results: The patient was discharged one day after surgery, there were no complications. The Foley bladder catheter was removed five days postoperatively, after cystography showed no extravasation. Histopathological diagnosis reported a rare mucinous cystic tumor of low malignant potential. The patient experienced no change in micturition six weeks after surgery. Discussion: A robot-assisted laparoscopy with cystoscopic assistance is a safe and feasible technique for a maximal bladder-sparing partial cystectomy.

Introduction: Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and methods: data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results: The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion: UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed. [ABSTRACT FROM AUTHOR]

Relatively little is known about allantois and urachal development in early humans. Serial sagittal histological sections from eight human embryos and fetuses were examined to determine allantois development. At gestational age 6–7 weeks, the primitive allantois consists of an enlarged tube located between the umbilical cord and abdominal cavity, whereas the urachus is not yet developed. At 8 weeks, the allantois gradually withdraws from the distal to the proximal end of the umbilical cord, and both the proximal allantois and the rectum (hindgut) start to develop into the cloaca. At 10 weeks, the allantois was located mostly in the abdominal cavity. The urachus forms from the distal end of the allantois and develops into a closed fibrous cord between the base of the urinary bladder and the umbilicus. The urogenital sinus forms from the proximal end of the allantois. [ABSTRACT FROM AUTHOR]

Backgrounds: This study aims to describe and evaluate outcomes of transurethral surgery-natural orifice transluminal endoscopic surgery (TUS-Notes) technique in patients treated with transurethral excision of vesico-urachal diverticula (VD). Methods: Patients who underwent TUS-Notes following transurethral VD excision due to recurrent urinary tract infection (rUTI) since 2013 were included in this prospective non-randomized cohort study. Under cystoscopic guidance VD and surrounding bladder wall was resected until the fatty tissue using monopolar resectoscope. The specimen was removed with a grasper through the cystoscope. TUS-Notes technique was performed with Minimal Suturing Device (MSD-Ney®). The needle of the suture was shaped according to suturing position and loaded into MSD-Ney. They were inserted into the bladder under cystoscopic guidance transurethrally. Once the defect was sutured properly, an extracorporeal knot was prepared and tied. The length of the operation (LOO), and perioperative complications according to the Clavien–Dindo grading system were noted. The integrity of the bladder was checked with cystography to assess objective cure. Subjective cure was evaluated with Patient Global Impression of Improvement (PGI-I) scale. Results: The follow-up period of 65 participants varied from three months to eight years. The median LOO was 37 min. A Clavien grade-3 complication was observed in one patient. Peroperative failure was not noted. The median duration of hospital stays, and catheterization time was three days. Objective cure rate and subjective cure rates were 100%. UTI was not noted after surgery. Conclusions: Transurethral complete excision of VD is an acceptable technique to prevent rUTI. The TUS-Notes technique provides a successful minimal invasive treatment option for the treatment of bladder defects. Concise: Transurethral suturing of urinary bladder. [ABSTRACT FROM AUTHOR]

Background: The urachus is an embryonic remnant occurring as a result of the involution of the allantoic duct and the ventral cloaca. This canal becomes progressively obliterated after birth. It uncommonly persists to different degrees after birth. Case Description: A young bull was presented with distended abdomen and clinical signs of chocking, with lowgrade fever, loss of appetite, frothy mouth arched back. On the first inspection, the animal was suspected to have simple indigestion. The treatment was attempted in this stage by introducing a stomach tube but only little relief was achieved. Therefore, 5 days later, an exploratory laparotomy was done and a big balloon-like cyst structure extended ventro-latrally in the abdominal cavity was noticed. That structure was located on the floor of the abdominal cavity extending from the pelvic rim caudally to the umbilical region cranially. The structure was then incised and evacuated and a rubber tube was fixed for constant drainage for up to one month later. The bull was followed-up and made a good recovery after a month post-surgery. Conclusion: We found that urachal abscess could be treated simply via surgical evacuation of the abscess and proper drainage for some time with a very promising outcome. Additionally, this affection can be diagnosed based on history, clinical signs, and exploratory surgery, when relatively modern diagnostic techniques are not available. [ABSTRACT FROM AUTHOR]

Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important. [ABSTRACT FROM AUTHOR]

IntroductionUrachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC.Material and Methodsdata has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020.ResultsThe median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment.ConclusionUrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.