Intravesical urachal cyst masquerading as a bladder malignancy: a case report.
Bladder malignancy
Congenital urachal anomaly
Intravesical urachal cyst
Magnetic resonance imaging
Rhabdomyosarcoma
Ultrasound
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
24 Aug 2023
24 Aug 2023
Historique:
received:
05
04
2023
accepted:
02
08
2023
medline:
25
8
2023
pubmed:
24
8
2023
entrez:
23
8
2023
Statut:
epublish
Résumé
Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a unique case of a urachal cyst masquerading as a bladder malignancy. Unlike the typical location of urachal cysts along the course of the urachal tract, the cyst in this case was unexpectedly situated within the urinary bladder, leading to diagnostic difficulties. A 2-year-old Bahraini boy presented with hematuria and dysuria for 2 weeks. There was no history of fever, abdominal pain, or vomiting. Physical examination yielded normal findings. Urinalysis showed numerous red blood cells and revealed positive results for nitrites and leukocyte esterase. Abdominal ultrasound showed a well-defined soft tissue lesion with internal vascularity located at the apex of the urinary bladder. Subsequently, magnetic resonance imaging demonstrated a thick-walled cystic structure arising from the anterosuperior wall of the bladder and protruding into its lumen. The patient underwent complete excision of the bladder lesion for the presumed diagnosis of rhabdomyosarcoma. Histopathological examination showed a fluid-filled space lined by stratified squamous epithelium with areas of intestinal metaplasia, revealing an unexpected diagnosis of a urachal cyst. The patient was discharged with complete resolution of symptoms. Intravesical urachal cysts are a rare type of congenital urachal anomaly that may simulate a bladder malignancy, particularly if associated with infection. This case emphasizes the importance of considering urachal cysts in the differential diagnosis of bladder masses, especially in children, and specifically when the lesion is midline in the anterosuperior wall of the bladder.
Sections du résumé
BACKGROUND
BACKGROUND
Urinary bladder masses in children are extremely rare. Certain benign conditions (e.g., ureterocele) can mimic malignant bladder masses. In this report, we present a unique case of a urachal cyst masquerading as a bladder malignancy. Unlike the typical location of urachal cysts along the course of the urachal tract, the cyst in this case was unexpectedly situated within the urinary bladder, leading to diagnostic difficulties.
CASE PRESENTATION
METHODS
A 2-year-old Bahraini boy presented with hematuria and dysuria for 2 weeks. There was no history of fever, abdominal pain, or vomiting. Physical examination yielded normal findings. Urinalysis showed numerous red blood cells and revealed positive results for nitrites and leukocyte esterase. Abdominal ultrasound showed a well-defined soft tissue lesion with internal vascularity located at the apex of the urinary bladder. Subsequently, magnetic resonance imaging demonstrated a thick-walled cystic structure arising from the anterosuperior wall of the bladder and protruding into its lumen. The patient underwent complete excision of the bladder lesion for the presumed diagnosis of rhabdomyosarcoma. Histopathological examination showed a fluid-filled space lined by stratified squamous epithelium with areas of intestinal metaplasia, revealing an unexpected diagnosis of a urachal cyst. The patient was discharged with complete resolution of symptoms.
CONCLUSIONS
CONCLUSIONS
Intravesical urachal cysts are a rare type of congenital urachal anomaly that may simulate a bladder malignancy, particularly if associated with infection. This case emphasizes the importance of considering urachal cysts in the differential diagnosis of bladder masses, especially in children, and specifically when the lesion is midline in the anterosuperior wall of the bladder.
Identifiants
pubmed: 37612773
doi: 10.1186/s13256-023-04110-w
pii: 10.1186/s13256-023-04110-w
pmc: PMC10463838
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
364Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Huppmann AR, Pawel BR. Polyps and masses of the pediatric urinary bladder: a 21-year pathology review. Pediatr Dev Pathol. 2011;14(6):438–44.
doi: 10.2350/11-01-0958-OA.1
pubmed: 21793666
Smereczynski A, Szopinski T, Golabek T, Ostasz O, Bojko S. Sonography of tumors and tumor-like lesions that mimic carcinoma of the urinary bladder. J Ultrason. 2014;14(56):36–48.
pubmed: 26672732
pmcid: 4579734
Shelmerdine SC, Lorenzo AJ, Gupta AA, Chavhan GB. Pearls and pitfalls in diagnosing pediatric urinary bladder masses. Radiographics. 2017;37(6):1872–91.
doi: 10.1148/rg.2017170031
pubmed: 29019749
Zhou AG, Amin A, Yates JK, Diamond DA, Tyminski MM, Badway JA, Ellsworth PI, Aidlen JT, Owens CL. Mass forming eosinophilic cystitis in pediatric patients. Urology. 2017;101:139–41.
doi: 10.1016/j.urology.2016.11.002
pubmed: 27840250
Yagishita H, Nagayama T, Zean Z, Ihara F, Hatori T, Nonaka H, Akima M, Yagishita H. A case of asymptomatic urachal cyst in autopsy–histopathological study of urachal cyst and review of the literature of 99 cases during a 10 year period in Japan. Hinyokika Kiyo. 2001;47(12):849–52.
pubmed: 11828771
Metwalli ZA, Guillerman RP, Mehollin-Ray AR, Schlesinger AE. Imaging features of intravesical urachal cysts in children. Pediatr Radiol. 2013;43(8):978–82.
doi: 10.1007/s00247-013-2628-y
pubmed: 23370693
Buddha S, Menias CO, Katabathina VS. Imaging of urachal anomalies. Abdom Radiol (NY). 2019;44(12):3978–89.
doi: 10.1007/s00261-019-02205-x
pubmed: 31478084
Wilson AL, Gandhi J, Seyam O, Rahmani B, Patel S, Joshi G, Smith NL, Khan SA. Urachal anomalies: a review of pathological conditions, diagnosis, and management. Transl Res Anat. 2019;16: 100041.
Copp HL, Wong IY, Krishnan C, Malhotra S, Kennedy WA. Clinical presentation and urachal remnant pathology: implications for treatment. J Urol. 2009;182(4 Suppl):1921–4.
doi: 10.1016/j.juro.2009.03.026
pubmed: 19695622
Choi YJ, Kim JM, Ahn SY, Oh JT, Han SW, Lee JS. Urachal anomalies in children: a single center experience. Yonsei Med J. 2006;47(6):782–6.
doi: 10.3349/ymj.2006.47.6.782
pubmed: 17191305
pmcid: 2687816
Gleason JM, Bowlin PR, Bagli DJ, Lorenzo AJ, Hassouna T, Koyle MA, Farhat WA. A comprehensive review of pediatric urachal anomalies and predictive analysis for adult urachal adenocarcinoma. J Urol. 2015;193(2):632–6.
doi: 10.1016/j.juro.2014.09.004
pubmed: 25219697
Castillo OA, Vitagliano G, Olivares R, Sanchez-Salas R. Complete excision of urachal cyst by laparoscopic means: a new approach to an uncommon disorder. Arch Esp Urol. 2007;60(5):607–11.
doi: 10.4321/S0004-06142007000500020
pubmed: 17718222
Ferrer FA, Isakoff M, Koyle MA. Bladder/prostate rhabdomyosarcoma: past, present and future. J Urol. 2006;176(4 Pt 1):1283–91.
doi: 10.1016/j.juro.2006.06.019
pubmed: 16952614
Stehr M. Pediatric urologic rhabdomyosarcoma. Curr Opin Urol. 2009;19(4):402–6.
doi: 10.1097/MOU.0b013e32832c90c2
pubmed: 19440152
Nogueras-Ocana M, Rodriguez-Belmonte R, Uberos-Fernandez J, Jimenez-Pacheco A, Merino-Salas S, Zuluaga-Gomez A. Urachal anomalies in children: surgical or conservative treatment? J Pediatr Urol. 2014;10(3):522–6.
doi: 10.1016/j.jpurol.2013.11.010
pubmed: 24321777
Galati V, Donovan B, Ramji F, Campbell J, Kropp BP, Frimberger D. Management of urachal remnants in early childhood. J Urol. 2008;180(4):1824–6.
doi: 10.1016/j.juro.2008.03.105
pubmed: 18721938
Gao H, Chen J, Li G, Cui X, Sun F. Pediatric laparoscopic partial cystectomy for the treatment of benign bladder tumors and urachal cysts. BMC Urol. 2021;21(1):128.
doi: 10.1186/s12894-021-00893-6
pubmed: 34526006
pmcid: 8444363