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Forum Name: Bladder Cancer

Question: Urachal growth


 Dodge - Fri Jan 01, 2010 1:29 pm

In September 2009 I ended up in the hospital with pain--turned out to be kidney stones. The scan that was done showed I had an enlarged urachal. In October I had a procedure when they went up and bioposied it from the inside of the bladder, the cells and muscle wall showed no cancer. The dr. sent me for an MRI and he suggested we would continue to monitor the part sticking out of the bladder...but after discussion, as I am a Remicade patient we have decided to have the surgery and cut it out now.

It is very dificult to find information, are urachal and bladder cancer the same thing? Does urachal cancer turn into bladder cancer? Is it possible to have this growth and not have cancer?

I also have colitis and have been on remicade for 1 year...my GI has informed me if this is cancerous, I would have to stop remicade and move towards having my colon removed.

I am 39 year old male, healthy (besides the colitis -- I've only had one major flare in 10 years, last year that led to the remicade.)

thank you.
 Dr.M.Aroon kamath - Mon Feb 22, 2010 5:43 am

User avatar Hi,
The urachus, is a midline tubular structure that extends upward from the dome of the urinary bladder to the umbilicus in fetal life. The tubular urachus normally involutes prior to birth, only remaining as a fibrous vestigial remnant with no known function(median umbilical ligament).

Histologically,it is a three-layered tubular structure, with the innermost layer being lined by transitional epithelium in 70% of cases and with columnar epithelium in 30%. This is surrounded by connective tissue and an outermost muscular layer in continuity with the detrusor muscle of the urinary bladder.

Diseases associated with persistent urachus are relatively rare. Congenital urachal anomalies are more common in men than in women(2:1).

There are four basic types of congenital urachal anomalies: a patent urachus, umbilical-urachal sinus, vesicourachal diverticulum, and urachal cyst.

Vesico-urachal diverticulum(more relevant from point of view of your problem) - Here,the urachus communicates only with the bladder dome. This condition results when the bladder end of the urachus fails to close. This lesion tends to manifest in patients with chronic bladder outlet obstruction and may be complicated by urinary tract infection, intra-urachal calculus formation, and an increased prevalence of carcinoma after puberty.

Benign urachal neoplasms are extremely rare; however, they are important as they mimic urachal malignancies.Malignant urachal neoplasms are also rare, representing <0.5% of all bladder cancers. Although the persistent urachus is most commonly lined by the transitional epithelium, urachal carcinoma predominantly manifests as adenocarcinoma (in approx 90% of cases), probably due to the metaplasia of the urachal mucosa into columnar epithelium followed by malignant transformation or due to the fact that in about 30% of cases(as alluded to earlier), urachal mucosa may be lined by columnar epithelium. These tumors are most commonly seen in patients 40–70 years of age.

95% of the primary bladder neoplasms are transitional cell carcinomas. These usually arise from the lateral walls of the urinary bladder(47%) or from the trigone(21%).

Adenocarcinomas arising from the urinary bladder are rare(3% of all bladder cancers).They usually arise from the bladder trigone.

Urachal carcinomas arise in the juxtavesical portion of the urachus and extend upward (in the perivesical space) towards the umbilicus and downwards through the bladder wall . Thus, urachal carcinomas may be confused with primary tumors of the bladder dome.

A CT scan or an MRI will usually be able to differentiate between a tumor arising from the urachus from a primary bladder tumor.
Good luck!

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