Maslov, Diana, V; Thomas, Katharine; Matrana, Marc
The urachus is a fibrotic remnant of the allantois, a canal that collects liquid waste and exchanges gases from the fetal bladder with the umbilical cord. Urachal cancer is a rare and aggressive cancer that often presents as adenocarcinoma at the dome of the bladder.; If urachal carcinoma is found early and confined to the urachus, cystectomy with en bloc resection of the urachal ligament and umbilicus can be curative. For unoperable patients, chemotherapy has a low rate of efficacy.; In this case we explore the effects of Gem-FLiP (gemcitabine, 5-fluorouracil, leucovorin, and cisplatin) in the treatment of urachal carcinoma, a regimen that is undergoing clinical trials. A 76-year-old man with a long history of genitourinary disease presented with gross painless hematuria. A flexible cystoscopy showed a sessile tumor at the dome of the bladder. A computed tomography (CT) urogram of the abdomen and pelvis confirmed a mass at the dome of the bladder. A CT-guided biopsy revealed adenocarcinoma consistent with urachal cancer.; After beginning treatment with Gem-FLiP, he developed pedal edema as well as drainage of the umbilicus. A CT scan of the abdomen and pelvis showed an anterior extension through the abdominal wall just below the umbilicus with central hypoattenuation within the mass; this represented a fistula between the bladder and umbilicus, along the tract of the urachal ligament, therefore confirming the diagnosis of urachal cancer.; This case illustrates a clinical scenario in which urachal carcinoma was confirmed when the entire cancerous urachus fistulized in response to treatment with systemic chemotherapy. It is highly unusual that a response to chemotherapy confirms a diagnosis. (C) 2019 Elsevier Inc. All rights reserved.