- Department of Neurosurgery, Shizuoka City Shimizu Hospital, Shizuoka,
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, Shizuoka City Shimizu Hospital, Shizuoka,
DOI:10.25259/SNI_79_2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Kento Takahara, Yoichi Mochizuki, Shinya Ichimura, Yutaka Kurebayashi, Koji Fujii. Brain metastasis from urachal carcinoma. 02-Aug-2019;10:152
How to cite this URL: Kento Takahara, Yoichi Mochizuki, Shinya Ichimura, Yutaka Kurebayashi, Koji Fujii. Brain metastasis from urachal carcinoma. 02-Aug-2019;10:152. Available from: http://surgicalneurologyint.com/surgicalint-articles/9556/
Background: Urachal carcinoma (UC) is a rare variant of bladder carcinoma. Only seven cases of brain metastasis from UC have been reported in the literature thus far.
Case Description: A 77-year-old female was diagnosed with a brain tumor in her left cerebellum 2 years after she underwent surgery for a primary UC in the bladder. Surgery was performed via a midline suboccipital approach and the tumor was totally removed. The excised lesion was pathologically diagnosed as a metastasis and displayed typical pathological features of urachal adenocarcinoma with abundant mucin mixed with signet ring cells. A recurrence was observed at the site of tumor removal 6 months after surgery, and then, gamma knife radiotherapy was performed to the lesion.
Conclusion: According to the five previously reported similar cases and our case, tumor removal is the treatment of choice. Routine whole brain radiotherapy is not the best treatment choice; however, local radiotherapy including conventional local radiotherapy or gamma knife radiotherapy could be implemented instead.
Keywords: Brain metastasis, Radiotherapy, Urachal carcinoma
Urachal carcinoma (UC) is a rare urological tumor, accounting for 0.17–0.34% of all bladder carcinomas.[
A 77-year-old female had been diagnosed with UC and had undergone total cystectomy 2 years prior to presentation with dizziness for which she was referred to our department. Magnetic resonance imaging revealed a 35-mm sized lesion in the left cerebellum. This lesion showed low intensity on T1-weighted images, high intensity with perifocal edema on T2-weighted images, and avid heterogeneous enhancement on T1-weighted images after gadolinium administration [
Preoperative magnetic resonance imaging showing a 35-mm sized mass in the left cerebellum that showed low intensity on T1-weighted image (left), high intensity with perifocal oedema on T2-weighted image (middle), and heterogeneous enhancement on T1-weighted image with gadolinium administration (right).
UC is a rare variant of bladder carcinoma which differs from normal bladder carcinoma in several ways: Instead of arising from the urothelium, it is believed to originate from an urachal remnant that underwent intestinal metaplasia or from progenitor cells of the cloaca left behind during embryologic development. This theory is reflected in the pathohistological differences observed between these two cancer types.[
Generally speaking, UC is treated in a way comparable to normal bladder carcinoma. Surgery is the treatment of choice, whereas chemotherapy and radiotherapy can be chosen for advanced cases. In cases with infiltration of adjacent organs or with distant or lymph node metastasis, poor prognosis is expected; the 5-year survival rate is believed to be 20% or less.[
As of now, seven cases of brain metastasis from UC have been reported.[
According to the five cases and our own case, the efficacy of radiotherapy remains unclear. Whole brain radiotherapy was provided in one case for multiple lesions, but there was no effect on tumor size.[
We reported a rare case of brain metastasis from urachal carcinoma. According to the five previously reported similar cases and our case, tumor removal is the treatment of choice. Routine whole brain radiotherapy is not the best treatment choice; however, local radiotherapy including conventional local radiotherapy or gamma knife radiotherapy could be implemented instead.
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
There are no conflicts of interest.
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