病例報告與文獻回顧：似惡性腫瘤表現之臍尿管膿瘍併腺性膀胱炎

陳柏翰¹、陳毅軒¹、曾仁澍¹

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

Concurrent urachal abscess and florid cystitis glandularis masquerading as malignancy: A case report and literature review

Bo-Han Chen¹, Yi-Hsuan Chen¹, Jen-Shu Tseng¹

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan¹

Background:

During embryogenesis, the allantois and cloaca give rise to the urachus, which then involutes and obliterates into the median umbilical ligament. [1] Failure of this process can lead to pathological conditions and complications later in life. Infection and malignancy arising from urachal remnants are the main complications in adults. [2] Urachal abscess and carcinoma share overlapping presentations and imaging features, and cases of one entity mimicking the other have been reported. [3, 4]

Cystitis glandularis is a proliferatiive disorder of bladder epithelium, which is possibly caused by normal urothelium reacting to chronic irritation such as infection or malignancy. [5]

Herein, we report a patient who was initially diagnosed and treated for urachal cancer with bladder invasion. Pathology later revealed urachal abscess and cystitis glandularis. We also review the clinical presentations, imaging features, and management of urachal mass and cystitis glandularis.

Case presentation:

A 57-year-old female was diagnosed with an ovarian cyst and referred to our hospital. Transvaginal ultrasound showed a 6-cm heterogeneous pelvic mass with mixed echogenicity located anterior to the uterus. Computed tomography (CT) showed an enhancing pelvic mass with solid and cystic components closely abutting the bladder dome and abdominal wall. No enlarged pelvic lymph nodes or distant metastases were noted (shown in Fig. 1).

Cystoscopy revealed protruding tumors in the bladder dome (shown in Fig. 2. a). Complete blood count, serum biochemistry, and tumor markers including carcinoembryonic antigen and carbohydrate antigen 125 were normal. Urinalysis showed microscopic hematuria.

As a malignant tumor of the urachus was suspected, the patient underwent en bloc surgical excision of the umbilicus, tumor, and involved bladder dome. Pathology reported a 6-cm necrotic mass with abscess formation and the focal presence of urachal remnants. Cystitis glandularis was identified in the resected bladder (shown in Fig. 2. b). Cytokeratin staining confirmed the absence of malignancy.

Conclusion:

A bladder infection may result in both urachal remnant infection with subsequent abscess formation and cystitis glandularis in chronic settings. To the best of our knowledge, our patient is the first reported case to have both of these diseases concurrently.

In conclusion, urachal abscess is a rare condition in adults. It is challenging to distinguish urachal abscess from a malignant tumor based on clinical presentation and imaging studies. As in our case, the coexistence of urachal abscess and tumor-like florid cystitis glandularis is possible, which increases the difficulty in making a correct diagnosis. This combination of diseases should be taken into consideration as one of the differential diagnoses.