Metastatic urachal carcinoma in bronchial brush cytology
A 47-year-old female was seen initially in August 2007 with urinary frequency and hematuria. Cystoscopy and biopsy of a dome lesion revealed adenocarcinoma. She was treated by partial cystectomy with en bloc resection of the median umbilical ligament and umbilicus. The surgical specimen revealed a 1.1 cm moderately differentiated adenocarcinoma with focal mucin extravasation invading deep muscle. The closest margin was 7 mm from the invasive front. No lymphovascular invasion was identified. Subsequent cystogram and imaging studies showed no residual tumor. Follow-up over the next 4 years were negative for signs of recurrence.\nIn July 2011, the patient presented with new onset of shortness of breath and stridor. Imaging studies showed a left lung mass with mediastinal adenopathy. Bronchoscopy showed an endobronchial obstructive lesion. A bronchial brush and tissue biopsies were obtained.\nThin Prep slide of bronchial brushings showed small sheets of columnar cells with medium size nuclei, mildly irregular nuclear membranes, coarse chromatin pattern, and abundant vacuolated cytoplasm in a background of mucin. These cells lacked cilia and were the predominant population when compared with the sparse presence of ciliated bronchial cells. The lesional cells were positive for CK20 and CDX2 but negative for CK7 (performed on Thin Prep slides, ). Due to insufficient cytologic material, TTF-1 was performed on the biopsy and was negative.\nThe concurrent biopsy and the previous resection specimens showed similar cytomorphologic features and immunohistochemical profiles []. Based on these findings, a final diagnosis of metastatic urachal adenocarcinoma was made.