Urachal carcinoma: imaging findings
A 46-year-old woman presented at our hospital with recurrent pelvic pain and frequent daytime urination of three months duration. Her medical history was unremarkable.\nDespite suprapubic tenderness on palpation, physical examination was normal.\nComplete blood count revealed marked increase in CEA to 1603 ng/mL (reference value <4 ng/mL) and slight increase in CA 125 to 46.5 U/mL (reference value <35 U/mL).\nPelvic ultrasound revealed a supravesical complex cystic mass with foci of increased echogenicity, suggestive of calcifications (Fig. ).\nOn contrast-enhanced CT it was seen a heterogeneous mass, of approximately 12.5 cm, extending through the anterosuperior wall of the bladder to the right flank. The lesion revealed low-attenuation and multiple dystrophic calcifications, suggestive of mucinous adenocarcioma. There was no evidence of local or distant metastases (Fig. ).\nMR was performed to better characterize the lesion and revealed a large inhomogeneous mass in contact with the dome and superior wall of the bladder and occupying the right flank. The lesion showed high signal intensity on T2-weighted images and intermediate signal on T1-weighted images. After intravenous contrast administration the mass enhanced slightly peripherally (Fig. ).\nOpen laparotomy revealed that the lesion was strongly adhered to the wall of the bladder and partial cystectomy with en-bloc resection of the mass was performed. Histologic analysis revealed an urachal mucinous adenocarcinoma.