Treatment of metastatic urachal carcinoma in an elderly woman

Background A 67-year-old woman with a history of smoking presentedwith abdominal pain and hematuria. On physical examination, she had a palpable pelvic mass. Imaging revealed a large pelvic mass situated on the dome of the bladder, extending from the urachus, without evidence of other sites of metastases. After resection, urachal adenocarcinoma was histologically confirmed. No adjuvant therapy was administered. Repeat imaging obtained 3 months after resection revealed a large left pelvic mass consistent with recurrence. Investigations Physical examination, pelvic and complete lymph-node examination, laboratory tests, urine analysis, CT scan of the abdomen and pelvis, chest X-ray, bone scan, cystoscopy, histologic examination of tumor morphology, and MRI of the abdomen and pelvis. Diagnosis Metastatic urachal adenocarcinoma. Management Surgical excision combined with cystectomy and pelvic lympadenectomy, chemotherapy with 5-fluorouracil, leucovorin, and irinotecan.