AJR 2003; 180:1183-1184
© American Roentgen Ray Society
Urachal Mucinous Cystadenocarcinoma with a Cystic Ovarian Metastasis
Shin Yanagisawa,
Yasunari Fujinaga and
Masumi Kadoya colleagues
Shinshu University School of Medicine Nagano 390-8621,
Japan
Urachal carcinoma is a rare tumor, and presentation with large gelatinous
lesions (pseudomyxoma peritonei) has been reported in only one patient
[1]. Urachal tumors show a
tendency to early local infiltration and systemic metastases to the lung,
brain, liver, and bone [2,
3]. Ovarian metastasis seems to
be rare, with no such lesions reported to our knowledge. We report a patient
with a urachal carcinoma with large ovarian metastasis mimicking pseudomyxoma
peritonei.
A 50-year-old woman who complained of lower abdominal fullness was
hospitalized in the department of gynecology for abdominal examination.
Laboratory analysis showed an elevation of carcinoembryonic antigen (27.9
ng/mL; normal, <3.0 ng/mL). Enhanced abdominal CT revealed two cystic
tumors in the pelvic cavity. One measured 10 x 14 x 16 cm; the
other measured 3.5 x 2.6 cm and contained slight calcification. The
small cystic tumor was located anterior to the larger one and was in contact
with the midline abdominal wall.
On axial and sagittal fat-saturated T2-weighted MR images, both lesions
appeared markedly hyperintense (Figs.
4A and
4B). Sagittal images showed
that the small tumor was located at the bladder dome (Figs.
4B and
4C). The small cystic tumor had
a hypointense wall, and its posterior wall was partially ruptured. The large
cystic tumor was located behind the small one and extended into the pouch of
Douglas (Figs. 4B and
4C). The wall and the septa of
the large tumor were well enhanced on sagittal gadolinium-enhanced
fatsaturated T1-weighted MR images (Fig.
4C). We suspected a urachal mucinous adenocarcinoma with
pseudomyxoma peritonei.
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Fig. 4A. —50-year-old woman with large metastatic ovarian tumor
originating from urachal mucinous adenocarcinoma. On axial (TR/TE, 3000/81.7)
(A) and sagittal (3000/90.2) (B) T2-weighted fast spin-echo MR
images, two cystic tumors appear markedly hyperintense. Wall of small tumor is
partially ruptured (arrows). Large cystic tumor extends into pouch of
Douglas (arrowhead, B).
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Fig. 4B. —50-year-old woman with large metastatic ovarian tumor
originating from urachal mucinous adenocarcinoma. On axial (TR/TE, 3000/81.7)
(A) and sagittal (3000/90.2) (B) T2-weighted fast spin-echo MR
images, two cystic tumors appear markedly hyperintense. Wall of small tumor is
partially ruptured (arrows). Large cystic tumor extends into pouch of
Douglas (arrowhead, B).
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Fig. 4C. —50-year-old woman with large metastatic ovarian tumor
originating from urachal mucinous adenocarcinoma. Sagittal gadolinium-enhanced
fat-saturated T1-weighted spin-echo MR image (600/10) shows enhanced walls and
septa of tumors.
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Surgery revealed that the large cystic tumor on CT and MR images
corresponded to the right ovary and the small one, to a urachal tumor. The
ruptured posterior wall of the urachal tumor was visible, and mucinous
material was evident in the abdominal cavity. The resected urachal tumor was
filled with white gelatinous material (Fig.
4D). The large right ovarian tumor consisted of multilocular cysts
containing white and brown gelatinous material. Histopathologic examination
revealed that each of the tumors was a mucinous cystadenocarcinoma.
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Fig. 4D. —50-year-old woman with large metastatic ovarian tumor
originating from urachal mucinous adenocarcinoma. Photograph of gross specimen
shows that urachal tumor is filled with white gelatinous material
(arrow).
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In this patient, the small cystic tumor showed the same typical imaging
findings as urachal mucinous adenocarcinoma in that it was located at the dome
of the bladder in the midline of the body, showed small calcifications on CT,
and appeared markedly hyperintense on T2-weighted MR images. However, the
diagnosis of a large cystic tumor was difficult because the markedly
hyperintense area behind the urachal tumor on T2-weighted images was
contiguous with the ruptured portion of the wall of the small lesion and
continued into the pouch of Douglas.
These findings suggested that the mucinous content of the ruptured smaller
tumor had spread into the peritoneal cavity. Retrospectively we could find
signs of a stretched right ovarian ligament and rounded upper border of the
large cystic tumor, which was not lobulated
(Fig. 4B), suggesting that the
large cystic lesion likely originated in the right ovary and not the
peritoneal cavity. Although this was a rare case, the correct diagnosis was
facilitated by detailed image interpretation focusing on the anatomic
relationships.
References
- Bree ED, Witkamp A, Van De Vijver M, et al. Unusual origins of
pseudomyxoma peritonei. J Surg Oncol
2000;75:270
–274[Medline]
- Yu JS, Kim KW, Lee HJ, et al. Urachal remnant diseases: spectrum of
CT and US findings. Radio-Graphics
2001;21:451
–461[Abstract/Free Full Text]
- Dunnick NR, McCallum RW, Sandler CM. The urinary bladder. In:
Grayson TH, ed. Textbook of uroradiography. Baltimore:
Williams & Wilkins, 1991:337
–338
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