Adenocarcinoma of the Urachus: Case Report

Abstract

Urachal adenocarcinoma is a rare malignancy, accounting for approximately one-third of all bladder adenocarcinomas, about 0.01% of all adult tumors, and 0.5% to 2% of all bladder neoplasms.
We present the case of a 70-year-old male referred for evaluation due to hematuria and mucosuria with a two-month evolution.
Imaging studies revealed a nodular lesion at the bladder dome, suggestive of urachal pathology. Urethrocystoscopy identified an exophytic lesion, and biopsy via transurethral resection confirmed the diagnosis of urachal adenocarcinoma. The patient underwent laparoscopic partial cystectomy with en bloc resection of the urachus and umbilicus, combined with bilateral iliac-obturator lymphadenectomy, without complications. Histopathological analysis confirmed a well-differentiated mucinous adenocarcinoma (pT2bN0M0) with negative surgical margins, no umbilical involvement, and no lymph node metastasis. The patient remains under regular clinical and imaging surveillance, including cystoscopy and thoracoabdominopelvic computed tomography scans, with no evidence of recurrence to date.
Although rare, urachal adenocarcinoma should be considered in the differential diagnosis of bladder dome lesions associated with hematuria. Partial cystectomy with concurrent urachal excision and lymphadenectomy represents an effective treatment approach in selected patients. Decisions regarding adjuvant therapy should be individualized. Postoperative surveillance is essential to detect early recurrences and manage residual urinary symptoms, contributing to improved quality of life.