Computed tomographic appearance of urachal adenocarcinomas: review of 25 cases

Twenty-five cases of surgically proven urachal carcinomas were retrospectively reviewed. The radiological archives at the Armed Forces Institute of Pathology were searched for cases of surgically proven urachal carcinomas that had a computed tomographic (CT) scan as a part of their radiologic evaluation. CT images from all cases were evaluated to determine tumor morphology, presence and localization of calcification, extent of bladder invasion and metastases. Tumor size at presentation averaged 6 cm. Twenty-one of 25 (84%) were mixed cystic solid lesions and 4/25 (16%) were completely solid. Calcifications were present in 18/25 (72%), with 11 peripherally located, 3 central only and 4 both. Bladder wall invasion was present in 23/25 (92%), but was seen as an intraluminal mass in only 13/25 (52%). The bulk of the mass was extravesicular in 22/25 (88%). Metastases were present in 12/25 (48%). Our series supports observations from other smaller series that a midline, calcified, supravesicular mass is highly suspicious, if not pathognomonic, for urachal carcinoma.