個案報告：原發性膀胱腺癌同步合併臍尿管囊腫與腺癌

陳柏翰¹、陳建志^{1, 2, 3}

¹台灣基督長老教會馬偕醫療財團法人馬偕紀念醫院 泌尿科；²馬偕學校財團法人馬偕醫學院；³馬偕學校財團法人馬偕醫護管理專科學校 化妝品應用與管理科

A Case Report: Primary Bladder Adenocarcinoma with Concurrent Urachal Cyst and Adenocarcinoma

Bo-Han Chen¹, Marcelo Chen^{1, 2, 3}

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan¹; School of Medicine, MacKay Medical College, New Taipei City, Taiwan²; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan³

Background

            Failure of urachus regression can cause diseases any time after birth. However, malignant urachal neoplasms are uncommon and predominantly adenocarcinoma, even though the urachus is commonly lined by urothelium. [1] On the one hand, bladder possessed similar feature that bladder adenocarcinoma is quite rare comparing to urothelial carcinoma. Here, we described a coincidental case of concurrent urachal and bladder adenocarcinoma from consultation by gynecologist.

Case presentation

               A 51-year-old menopause woman went to the outpatient clinic of Gynecology with the chief complaint of urinary frequency. Transvaginal echogram showed a uterus myoma. Under the impression of leiomyoma of uterus, she was admitted to Gynecologic ward for complicated hysterectomy. During the operation, we were consulted by the gynecologist because of incidental finding of a palpable mass lesion at urinary bladder. From the operative view, a round firm mass was noted attached to the bladder serosa. Furthermore, another papillary tumor was noted on the dome of bladder after bladder incision. Partial cystectomy was done. With fine dissection, all visible and palpable tumors were completely resected. (Figure 1) Both the tumors sent to pathology separately.

               Pathologic result showed leiomyoma and chronic cervicitis from hysterectomy specimen. However, the tumor from bladder serosa revealed urachal cyst with adenocarcinoma. Not only that,  the tumor from bladder dome showed a moderately differentiated adenocarcinoma. Onsection, the tumor appeared to invade into muscularis propria and is less than 0.1 cm away from the deep margin. The immunostain revealed positive from SATB2, CK20 and negative from GATA3(-), CK7 and CK34bE12. (Figure 2)

               The patient was discharged from hospital 4 days postoperatively without any complication. Due to the uncommon find of adenocarcinoma from genitourinary tract and negative finding from Gynecology, the patient was transferred to proctologist for colonoscopy. Colonoscopy was done up to cecum. The angulation at splenic flexure was noted. Two polyps at sigmoid and a polyp at rectum were found and resected.  However, both of them were negative of adenocarcinoma. They were tubular adenomas with low grade dysplasia and traditional serrated adenoma with low grade dysplasia, respectively. The relative lab data did not elevated during the follow-up at regular outpatient clinic, including CA-199 (25.19 U/mL) and CEA(1.11 ng/mL). Further fiberocytoscopy will be arrange 3 months after partial cystectomy.

Discussion and conclusion

            Urachal cancer is a rare cancer. However, advanced and aggressive cancer progression still had been reported. [2] The diagnosis of urachal carcinoma is difficult due both to the low tumor incidence and the overlapping of the histopathologic features with adenocarcinoma of other origins. [3] Immunohistochemistry plays an important role in differentiating adenocarcinoma of the urachus from other primitives. Moreover, primary adenocarcinoma of urinary bladder is also an uncommon malignancy which may not be easy to differentiate from adenocarcinoma arising from the colon and prostate without immuno-histochemistry. [4] More important, completely surgical resection, such as partial or radical cystectomy were advocated for localized bladder adenocarcinoma.