Urachal carcinoma is a rare and highly malignant form of bladder cancer (accounting for <1% of all bladder carcinomas). This aggressive cancer often evolves into distant metastasis. Because of its rarity, there is little knowledge of this devastating pathology.
We report the case of a young male patient with early-stage urachal carcinoma that had already metastasized to the bones.
 
CASE PRESENTATION: 
A 35-year-old male patient complaining of pain in the suprapubic region and hematuria underwent an ultrasound examination, which revealed a mass lesion with solid and cystic components closely related to dome of the bladder.
To rule out other related underlying diseases, the patient also underwent a computed tomography (Fig.1A), a magnetic resonance imagining (Fig.1B,1C) and a bone gammagraphy. The overall diagnosis revealed evidence of a solid prevesical cystic mass; two bone metastases were also detected in both the vertebral body D10 and right iliac fossa. Transurethral resection (Fig.2A) was performed and the anatomopathological diagnosis showed invasive mucus-secreting adenocarcinoma poorly differentiated with a component of signet-ring cells. After presenting this case to our Uro-Oncology Executive Committee, it was decided that a surgical resection and adjuvant chemotherapy would be the most suitable therapeutic approach. The resection was conducted through the umbilical area, urachal ligament and in the bladder dome (partial cystectomy: fig.2B) as well as a bilateral pelvic lymphadenectomy. The anatomopathological diagnosis of the surgical sample revealed an intestinal-type urachal mucinous cystadenocarcinoma that extended throughout the urachus. It was moderately demarcated, not invading the margins of the resected area, while the lymph nodes did not present tumorous affectation (Fig.3A-3B). One month after surgery, the patient received adjuvant chemotherapy with 145mg cisplatin and 2,450mg gemcitabine, and zoledronic acid every three months with good tolerance and no toxicity. Nine months after surgery, our patient presented no symptoms, and the metastasis had been brought under control with no apparent signs of recurrence as assessed in a follow-up CT. The patient granted his written consent for t publication of this clinical case.

Multimodal therapy in an early-stage urachal carcinoma with oligometastatic bone disease.