Urachal mucinous cystic tumor of low malignant potential in a polymorbid female: a case report and review of the literature

Abstract

Neoplasms of the urachus are exceedingly rare, representing 0.17% of all bladder cancers. The mucinous cystic tumor of low malignant potential (MCTLMP) subtype is particularly rare with just 25 previous cases reported in the literature. Although rare, MCTLMPs are important to identify due to potential devastating complications and good cure rates with surgical removal. We present a 43 year old female with a nuanced constellation of comorbidities and confirmed MCTLMP following a workup for abdominal pain and irritative lower urinary tract symptoms. Notably, this tumor did not change in size over a 3-year course of serial imaging prior to surgical excision. This urachal MCTLMP represents roughly the 26th and one of the smallest of its subtype reported in the literature. This case illustrates the diagnosis and management of this rare urachal MCTLMP. Individual patient medical history, clinical considerations, and neoplasm characteristics are examined. Although rare, the potential for increased malignancy and potential complications necessitates surgical management and further investigation by the academic community.

Keywords: Case report; Mucinous cystadenoma; Urachal cystadenoma; Urachus; Uro-oncology.

Fig. 1

A, B Histopathologic findings. Multiloculated cystic proliferation composed of a variably complex villous architecture, predominantly lined by a single layer of mucinous epithelium with mild to moderate cytologic atypia. A few mitotic figures are identified. Original magnifications, × 1 (A), × 10 (B)

Fig. 2

A, B Histopathologic findings. Mucinous cystic tumor of low malignant potential (MCTLMP). A focus of benign stratified urothelium is visualized on the right, transitioning to atypical mucinous epithelium on the left. Original magnifications, × 5 (A), × 10 (B)

Fig. 3

Sagittal view of non-calcified urachal cystic tumor as seen on CT imaging roughly 2 weeks pre-operative noted with white arrow. Tumor remained unchanged in size on imaging from 3 years prior to excision