URACHAL CARCINOMA ASSOCIATED WITH INCREASED CARBOHYDRATE ANTIGEN 19-9 AND CARCINOEMBRYONIC ANTIGEN

Abstract

A 41-year-old woman presented with intermittent gross hematuria in January 2000. Cystoscopic examination revealed a thumb tip sized, nonpapillary sessile tumor on the bladder dome. Diagnosis was adenocarcinoma, which was confirmed by transurethral tumor biopsy. Serum carbohydrate antigen 19-9 was 53 units per ml. (normal less than 35) and carcinoembryonic antigen was 6.9 ng./ml. (normal less than 2.5). Contrast enhanced computerized tomography of the abdomen and pelvis demonstrated a soft tissue density mass arising from the anterior wall of the bladder with infiltration into the anterior adipose tissue. There was no evidence of lymphadenopathy. Other radiological imaging studies excluded distant metastasis and primary bowel cancer. Total cystectomy with en bloc removal of the umbilicus, pelvic lymphadenectomy and ileal neobladder construction as urinary diversion were performed. Histopathological examination of a specimen revealed features of mucin secreting, well differentiated adenocarcinoma of the urachus (fig. 1). Postoperatively 2 cycles of adjuvant chemotherapy consisting of 5-fluorouracil, doxorubicin and cisplatin were administered because lymph node metastasis to a right external iliac node was demonstrated by frozen section examination. The patient was clinically free of disease with normal results on followup abdominal and pelvic computerized tomography, and normal levels of 2 serum tumor markers.