Metaplasia of urinary bladder induced by chronic irritation or infection can lead to adenocarcinoma. Pathological types of adenocarcinoma of urinary bladder are:
- mucinous adenocarcinoma
- signet-ring type
- papillary adenocarcinoma
- not otherwise specified (NOS)
Bladder adenocarcinoma may be subclassified as primary (two-thirds are non-urachal and one-third are urachal 2) or secondary (metastases).
- persistent urachal remnant (most common)
- cystitis glandularis (itself secondary to bladder outlet obstruction, chronic infection and/or bladder calculi)
- schistosomiasis (bilharziasis), especially where endemic
- associated with bladder exstrophy
- diffuse bladder wall thickening
- stranding of perivesical fat
- regional lymphadenopathy
- invasion of rectus muscles
- characteristically in midline at the dome of bladder, or along the course of urachus (from bladder to umbilicus)
- a midline, infraumbilical soft tissue mass with peripheral calcification is characteristically urachal adenocarcinoma, unless proven otherwise (calcification in 70% of cases)
- usually large tumours (5-6 cm) with prominent extravesical component
- mixed solid-cystic appearance in most cases
Solid components of tumour are isointense, while cystic mucinous component appears hyperintense on T2W images. Localising a urachal carcinoma may be easier on the sagittal images.
Treatment and prognosis
Due to their extravesical location, urachal carcinomas present very late and thus carry poor prognosis. Radical cystectomy is considered treatment of choice. However, en bloc resection of extravesical component, adjacent peritoneum and abdominal wall is also needed.
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