Mystery of neck lump: an uncommon presentation of urachal cancer

Abstract

We present the case of a 55-year-old male patient who presented with palpable cervical lymphadenopathy. Excisional biopsy showed metastatic adenocarcinoma of unknown origin. Imaging showed a bladder mass following which he underwent transurethral resection of bladder tumour. Histopathological evaluation of mass confirmed a poorly differentiated adenocarcinoma with signet-ring cell features. Immunohistochemistry was suggestive of metastatic urachal cancer. He agreed for enrollment in a clinical trial, however soon after 1st cycle, he developed immune pneumonitis requiring high dose steroids. On follow-up, MRI brain was done for evaluation of headache which showed metastatic intracranial disease. He completed radiotherapy following which he was started on FOLFOX chemo regimen (folinic acid, 5-fluorouracil and oxaliplatin).

Keywords: cancer intervention; malignant disease and immunosuppression; radiology (diagnostics).

Figure 1

(A) CT neck showing conglomerate lymph nodal mass with approximate dimensions of 4.4×4 cm. (B) Lymph nodal biopsy showing signet-ring cell features and extra nodal extension. (C, D) CT (abdomen/pelvis) showed large, lobulated enhancing (10×9.2×7 cm) mass diffusely involving the superior and posterior urinary bladder. (E) Histopathological evaluation from bladder mass revealed poorly differentiated adenocarcinoma with signet-ring cell features.

Figure 2

A, B and D CT pelvis showing persistent bladder mass, new left-sided hydronephrosis and left hip bone metastasis. (C) Chest X-ray showing interstitial pattern with no lobar consolidation. (E) High-resolution CT chest showing bilateral diffuse ground glass pattern.