urachal masses. dr saneej

Dr. K. Saneej DMRD,DNBRadiologist, PVS Hospital, Kozhikode

Kerala

rare urachal masses

Apr 12, 2023 ULTRAFEST

53 year old female•Complex cystic mass ant to UB•Iso to hyperechoic solid compnt

Mass projecting into UB lumen

3 months H/o Lower abd painRecurrent UTI, Passing of frothy urinePainless Hematuria

Apr 12, 2023 ULTRAFEST

Usg pelvisLesion Anterosuperior to UB

Apr 12, 2023 ULTRAFEST

Peripheral enhancement• Air within UB• Polypoidal, irregular

margins• Lobulated contour• Arising from ant wall of

UB• Central nonenhancing

area

• Contact with ant abd wall

• Epicentre may be anterior to UB

Apr 12, 2023 ULTRAFEST

diagnosis

• Urachal adenocarcinoma – Mucinous variety with local infiltration

• HPR: Poorly diff mucinous adenoca of signet-ring cell type Consistent with malignant transformation of a urachal cyst

Cystoscopy

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• One month old infant , c/o swelling , redness and crying on touching umbilicus

CASE ii

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Urinary bladderSagittalThickened cord like structure from dome

Leading to a cystic lesion

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Thick walled cystic lesionIn b/w UB dome & umbilicus

A Thickened cord above the cyst connecting to umbilicus

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Thick walled cyst in retzius spaceAxial cyst

Axial Cord

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urachal cyst with 20 infn

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Apr 12, 2023 ULTRAFEST

urachus

• Midline remnant of at least 2 embryonic structures– Cloaca & allantois

Continuity of ventral cloaca and allantois in an 8 wk fetus.

Urachal Remnant Diseases: Spectrum of CT & US Findings Jeong-Sik Yu, MD, Ki Whang Kim, March 2001 RadioGraphics, 21,451-461.

Apr 12, 2023 ULTRAFEST

patent urachusA. Normal obliteration of the Urachal lumen.B. Urachal cyst.C. Patent urachus.D. Urachal sinus.E. Urachal diverticulum.

(Guray, Sogut, et al. Urachal Cyst. Eastern Journal of Medicine 5 (2) : 76-78, 2000)

Apr 12, 2023 ULTRAFEST

late fetal life- urachus

• Deteriorates to a fibrous band• Median umbilical ligament• Extends from ant dome of bladder

toward umbilicus

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In our case

• Malignant transformation of a urachal cyst

Apr 12, 2023 ULTRAFEST

Retzius space

• Located extraperitoneally

• Bounded by transverse fascia ventrally & parietal peritoneum dorsally.

• Area is called the Retzius space

Apr 12, 2023 ULTRAFEST

clinical significance

• Typical extension of urachal ca along Retzius space helps d/d from vesical ca

Apr 12, 2023 ULTRAFEST

Histopathology

• Urachus: normally lined by transitional ep

• Urachal tumors = adenoca• Metaplasia of urachal mucosa into

columnar ep g malignant transformation

Apr 12, 2023 ULTRAFEST

Thank youDr. K.Saneej. DMRD,DNB(RD)

Radiologist, PVS HospitalKozhikode Kerala