臍尿管分化不良型尿路上皮癌之個案報告

梁柏崧  石宏仁

彰化基督教醫院泌尿外科

Poorly differentiated urothelial carcinoma of the urachus: A case report

Po-Sung Liang, Hung-Jen Shih

Division of Urology, Department of Surgery, Changhua Christian Hospital

Introduction:

Urachal cancer is an extremely rare malignancy and more than 90% are adenocarcinoma. We presented a case of primary urachal urothelial carcinoma with bladder invasion and external iliac lymph node metastasis.

Case presentation:

A 64-year-old man presented to our outpatient department with history of painless gross hematuria for two months. A bladder sonography as initial diagnostic assessment disclosed the presence of a peri-bladder mass. Computed tomography (CT) unveiled a 6.2 cm mass situated in the midline dome of the bladder and compounded by the identification of an enlarged lymph node in the left external iliac chain. Bone scan revealed no definite evidence of bony metastasis. Chest CT scan revealed no clinically significant lesion. Under the impression of urachal tumor with bladder invasion and external iliac lymph node metastasis, robot-assisted urachal tumor excision and partial cystectomy with bilateral external iliac lymph node dissection were done. During the operation, cystoscopy revealed a significant amount of hematoma within the bladder but no discernible papillary tumor. In robot-assisted laparoscopic view, the tumor was ultimately identified as protruding from the urachus tumor and exhibiting adhesion to the sigmoid colon. We performed adhesiolysis and removed the urachal tumor along with the median umbilical ligament and urachus en-bloc. Histopathological analysis of the excised tissue confirmed the diagnosis of poorly differentiated urothelial carcinoma of the urachus with bladder involvement. The surgical margin is free of cancer invasion. Multiple regional lymph node metastases were identified in the true pelvis, encompassing the perivesical, obturator, internal and external iliac, and sacral lymph nodes. To date, the patient is followed up in our outpatient department and received adjuvant therapy with chemotherapy (cisplatin combine with gemcitabine) and immunotherapy (pembrolizumab). Liver and intraperitoneal metastasis were noted in the 6 months after operation.

Conclusions:

The prognosis of primary urachal urothelial carcinoma with advanced stage is poor even treated with operation and adjuvant chemotherapy and immunotherapy.