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


Usg pelvisLesion Anterosuperior to UB


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


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


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

CASE ii


Urinary bladderSagittalThickened cord like structure from dome

Leading to a cystic lesion


Thick walled cystic lesionIn b/w UB dome & umbilicus

A Thickened cord above the cyst connecting to umbilicus


Thick walled cyst in retzius spaceAxial cyst

Axial Cord


urachal cyst with 20 infn



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.


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)


late fetal life- urachus

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

toward umbilicus


In our case

• Malignant transformation of a urachal cyst


Retzius space

• Located extraperitoneally

• Bounded by transverse fascia ventrally & parietal peritoneum dorsally.

• Area is called the Retzius space


clinical significance

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


Histopathology

• Urachus: normally lined by transitional ep

• Urachal tumors = adenoca• Metaplasia of urachal mucosa into

columnar ep g malignant transformation


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

Radiologist, PVS HospitalKozhikode Kerala

Health & Medicine

URACHAL MASSES. Dr Saneej