Presentation
Several year history of mucosuria.
Patient Data
Large, elongated mixed soft tissue and low attenuation mass with peripheral stippled calcifications extending cranially from the bladder dome.
Urachal mass is T2-hyperintense with thin reticular areas of internal enhancement toward the base. Periphery mildly enhances.
Case Discussion
Final pathology following surgical removal confirmed invasive urachal adenocarcinoma with mixed enteric and mucinous histology. While uncommon, mucinous adenocarcinoma can be suspected based on CT the due to (1) the location of the mass and (2) the low attenuation material with peripheral calcifications. The location is typical for urachal remnant mass, and the most common neoplasm in this location is adenocarcinoma (rather than urothelial). Imagine this mass superimposed to the appendix, and appendiceal mucocele (or mucinous adenocarcinoma) would be most suspected. The MRI helps to confirm the diagnosis with the characteristic T2 hyperintense mucin and relatively minimal enhancement, and is also useful for looking for T2 hyperintense implants.
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