Mucinous adenocarcinoma of urachus: A tailored approach

Vesical adenocarcinomas are uncommon, accounting for less than 2% of all malignant urinary bladder tumors. Of these, urachal adenocarcinoma represents a rare subset. We report a case of a urachal adenocarcinoma, highlighting its unique features and management. A 50-year-old female presented with hematuria and burning micturition. Computed tomography scan showed a mass arising from an outpouching in the apex of bladder, suggestive of urachal origin. Biopsy revealed moderately differentiated mucinous adenocarcinoma. Partial cystectomy with ileocystoplasty, excision of urachus along with umbilicus and pelvic lymph node dissection was done. Histopathology confirmed urachal mucinous adenocarcinoma. The pathogenesis of urachal adenocarcinoma is unknown. It is important to distinguish between urachal and non urachal adenocarcinoma as the former carry a better prognosis. Management of urachal adenocarcinoma involves complete eradication of the disease. Stage and margin status have been identified as the most important predictors of long-term survival.