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The British Journal of Radiology Jun 2020The urachus is a fibrous tube extending from the umbilicus to the anterosuperior bladder dome that usually obliterates at week 12 of gestation, becoming the median... (Review)
Review
The urachus is a fibrous tube extending from the umbilicus to the anterosuperior bladder dome that usually obliterates at week 12 of gestation, becoming the median umbilical ligament. Urachal pathology occurs when there is incomplete obliteration of this channel during foetal development, resulting in the formation of a urachal cyst, patent urachus, urachal sinus or urachal diverticulum. Patients with persistent urachal remnants may be asymptomatic or present with lower abdominal or urinary tract symptoms and can develop complications. The purpose of this review is to describe imaging features of urachal remnant pathology and potential benign and malignant complications on ultrasound, CT, positron emission tomography CT and MRI.
Topics: Abscess; Adult; Aged; Cell Transformation, Neoplastic; Child; Female; Fistula; Humans; Male; Medical Illustration; Middle Aged; Tomography, X-Ray Computed; Ultrasonography; Umbilicus; Urachal Cyst; Urachus; Urinary Bladder Fistula; Young Adult
PubMed: 32045264
DOI: 10.1259/bjr.20190118 -
Medicine Jan 2020Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a...
INTRODUCTION
Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient.
PATIENT CONCERNS
A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain.
DIAGNOSIS
Infected urachal cyst.
INTERVENTIONS
The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization.
OUTCOMES
The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery.
CONCLUSION
We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.
Topics: Abdomen, Acute; Child, Preschool; Humans; Male; Urachal Cyst; Urachus
PubMed: 32000391
DOI: 10.1097/MD.0000000000018884 -
Scientific Reports Jan 2020Cycling hypoxia (cyH), also called intermittent hypoxia, occurs in solid tumors and affects different cell types in the tumor microenvironment and in particular the...
Cycling hypoxia (cyH), also called intermittent hypoxia, occurs in solid tumors and affects different cell types in the tumor microenvironment and in particular the tumor-associated macrophages (TAMs). As cyH and TAMs both favor tumor progression, we investigated whether cyH could drive the pro-tumoral phenotype of macrophages. Here, the effects of cyH on human THP-1 macrophages and murine bone marrow-derived macrophages (BMDM), either unpolarized M0, or polarized in M1 or M2 phenotype were studied. In M0 macrophages, cyH induced a pro-inflammatory phenotype characterized by an increase in TNFα and IL-8/MIP-2 secretion. CyH amplified the pro-inflammatory phenotype of M1 macrophages evidenced by an increased pro-inflammatory cytokine secretion and pro-inflammatory gene expression. Furthermore, cyH increased c-jun activation in human M0 macrophages and highly increased c-jun and NF-κB activation in M1 macrophages. C-jun and p65 are implicated in the effects of cyH on M0 and M1 macrophages since inhibition of their activation prevented the cyH pro-inflammatory effects. In conclusion, we demonstrated that cyH induces or amplifies a pro-inflammatory phenotype in M0 and M1 macrophages by activating JNK/p65 signaling pathway. These results highlight a specific role of cyH in the amplification of tumor-related inflammation by modulating the inflammatory phenotype of macrophages.
Topics: Animals; Anthracenes; Cell Line; Cytokines; Gene Expression Regulation; Humans; MAP Kinase Signaling System; Macrophages; Male; Mice, Inbred C57BL; NF-kappa B; Nitriles; Proto-Oncogene Proteins c-jun; STAT1 Transcription Factor; Sulfones; Tumor Hypoxia; Tumor Microenvironment; Urachal Cyst
PubMed: 31964911
DOI: 10.1038/s41598-020-57677-5 -
International Journal of Surgery Case... 2020There is a wide differential diagnosis for intraabdominal tumors. Surgical resection and microscopic analysis of tissue structure can identify tumor origin in most...
INTRODUCTION
There is a wide differential diagnosis for intraabdominal tumors. Surgical resection and microscopic analysis of tissue structure can identify tumor origin in most cases. Most rapidly growing invasive tumors are neoplastic. Inflammatory pseudotumors are a subcategory of intraabdominal tumors that are non-neoplastic and can be rapidly growing. Urachal cysts originate from the dome of the bladder; however they are typically not invasive. There is limited literature on the appropriate management of these tumors.
PRESENTATION
A 37-year-old female presenting with symptoms of abdominal pain was found to have a large intraabdominal mass invading multiple organs. Core biopsies demonstrated inflammation. The mass grew significantly over the course of a year and patient's abdominal pain worsened. The patient was taken to the operating room for resection. Final pathology revealed reactive fibrous tissue with acute and chronic inflammation invading bladder, urethra, abdominal wall, appendix, and ovary. Intraoperative frozen section demonstrated low grade spindle cells with concern for inflammatory pseudotumor but final pathology demonstrated inflammation.
DISCUSSION
Although benign, these tumors cause significant morbidity due to their size and level of organ invasion. Management should involve surgical resection as well as potential post-operative chemotherapy or NSAIDs based off clinical picture. We demonstrate the importance of close follow up for residual disease or recurrence of patients with inflammatory pseudotumors of the abdomen.
CONCLUSION
This case highlights difficulties in diagnosis of a tumor that has potential to cause significant morbidity. There is need for further research to discover the best management after surgical resection of these tumors.
PubMed: 31927401
DOI: 10.1016/j.ijscr.2019.12.029 -
Acta Bio-medica : Atenei Parmensis Dec 2019The umbilicus is a unique physiologic scar of human life resulting from the healing process of the cut umbilical cord at birth. Its absence leads to an unnatural...
The umbilicus is a unique physiologic scar of human life resulting from the healing process of the cut umbilical cord at birth. Its absence leads to an unnatural abdominal appearance, and an abnormally shaped or misplaced umbilicus may draw undue attention to the central abdomen. Loss of the umbilicus can be an embarrassing deformity; this occurs when older techniques of umbilical hernia or incisional hernia repair are employed and after abdominoplasty, urachal cyst repair, omphalocele repair, gastroschisis repair, some tumor excisions, and mobilization of bipedicled or bilateral TRAM/DIEP flaps for breast reconstruction. Umbilicoplasty, in which the umbilicus remains anchored to the deep abdominal fascia but is transposed through a newly-formed aperture in the upper abdominal skin flap, is performed in abdominoplasty either for abdominal flap harvest or purely for aesthetics. On the other hand, umbiliconeoplasty describes the de novo creation of an umbilicus that is absent for either congenital or acquired reasons. The optimal umbilical reconstruction should be reliable, reproducible, aesthetically appropriate, and associated with low morbidity. Ideally, it is also single-staged, except in the case of an infected wound, in which case a delayed primary approach may be prudent. (www.actabiomedica.it).
Topics: Cicatrix; Humans; Plastic Surgery Procedures; Surgical Flaps; Umbilicus
PubMed: 31910176
DOI: 10.23750/abm.v90i4.7539 -
Iranian Journal of Parasitology 2019The hydatid cyst (HC) is an endemic parasitic disease worldwide. Although the HC can locate in every part of a body, it rarely occurs over the abdominal wall. A...
The hydatid cyst (HC) is an endemic parasitic disease worldwide. Although the HC can locate in every part of a body, it rarely occurs over the abdominal wall. A 12-year-old female patient was brought to Department of Pediatric Surgery, Firat University School of Medicine, Elazig, Turkey in 2017. She had been suffering from abdominal pain for one week. A lump was determined underneath her skin in the suprapubic region. It was swollen, tense and movable. A cystic mass filling the midline was found in the radiological bladder superior. It was an anechoic cyst causing ondulation on the muscles of the anterior abdominal wall. The sizes of the mass were measured approximately as 9×7 cm (mesentery cyst?). The cystic mass was occurred in the urachal area of the anterior abdominal wall, not in the abdomen. After the cyst was emptied with applying mini median incision below the umbilicus, we saw the germinative membrane inside the cyst. Diagnosis of the HC was confirmed with the pathologic evaluation. For the differential diagnosis of a pure cystic mass, which can locate in every part of a body, diagnosis of the HC should be considered.
PubMed: 31543926
DOI: No ID Found -
Medical Ultrasonography Aug 2019This study's aim is to present the specific ultrasonography (US) findings of a series of urachus anomalies.
AIMS
This study's aim is to present the specific ultrasonography (US) findings of a series of urachus anomalies.
MATERIAL AND METHODS
Seven patients with suspected urachal anomalies underwent US scanning initially prior to the surgery and the features of images were reviewed respectively. The clinical data and pathologic results were collected also.
RESULTS
US successfully diagnosed urachal anomalies in 5 patients (5/7, 71.4%) and failed to diagnose in 2 patients (2/7, 28.6%). Patent urachus showed a tubule between the umbilicus and bladder; urachal sinus was a blind focal dilatation at the umbilical end, while vesicourachal diverticulum was an outpouching at the vesical end and urachal cyst was identified as an anechoic structure along the urachus. Non-enhancement in the base and centre was the distinct features of urachus carcinoma by contrastenhanced ultrasonography (CEUS). Using a high frequency probe and CEUS the diagnostic ability of US may be improved.
CONCLUSION
US showed good diagnostic ability in urachal anomalies and combined with CEUS could improve the differential diagnosis.
Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Ultrasonography; Urachal Cyst; Urachus; Urinary Bladder Neoplasms
PubMed: 31476210
DOI: 10.11152/mu-1878 -
Journal of Surgical Case Reports Jul 2019A urachus is a vestigial tubular structure that connects the urinary bladder to the allantois during early embryonic development. Urachal remnants are classified as...
A urachus is a vestigial tubular structure that connects the urinary bladder to the allantois during early embryonic development. Urachal remnants are classified as patent urachus, urachal sinus, urachal cyst, and urachal diverticulum. Ten patients with urachal remnants underwent surgery at our institution between 2015 and 2019. Six patients had a urachal sinus, and four had a urachal diverticulum. Two patients with urachal sinus underwent excision of the urachal remnant, from the umbilicus to the urinary bladder, using an umbilical approach. The other four patients with urachal sinus underwent laparoscopic surgery with excision of the urachal remnant, from the umbilicus to the urinary bladder. All patients with urachal diverticulum underwent open excision of the diverticulum through a Pfannenstiel incision. Pathologic examination of all urachal remnants showed no evidence of neoplasm and complete excision. All patients had an uneventful postoperative course and are doing well.
PubMed: 31384429
DOI: 10.1093/jscr/rjz222 -
Urology Case Reports Sep 2019The urachus is an embryologic remnant which degenerates after the birth. An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of...
The urachus is an embryologic remnant which degenerates after the birth. An infected urachal cyst is one of a spectrum of presentations of urachal pathology, all of which are rare in adulthood. Infected urachal cyst is a rare pathology in adult women and it should be considered in the differential diagnosis of acute abdomen. We report here a case of a 50-year-old women with an infected urachal cyst reveled by an acute abdomen.
PubMed: 31380223
DOI: 10.1016/j.eucr.2019.100976 -
Radiology Case Reports Oct 2019Urachal cyst is a rare condition that is typically asymptomatic and will often have symptomatology that is misdiagnosed or missed. A urachal cyst occurs in 1 out of 5000...
Urachal cyst is a rare condition that is typically asymptomatic and will often have symptomatology that is misdiagnosed or missed. A urachal cyst occurs in 1 out of 5000 live-births, but is only clinically relevant in 1 out of 150,000 of the population often as an incidental finding. The urachus is the embryological remnant of the allantois, which connects the apex of the bladder to the umbilicus, and usually fully obliterates to become the median umbilical ligament. Urachal defects are uncommon and cysts are usually asymptomatic until infection results. An infected cyst may present mimicking a wide range of intra-abdominal and pelvic disorders, and accurate diagnosis is often delayed. Children may present with umbilical discharge; adults often have hematuria. Computed tomography (CT) and ultrasound are ideally suited for demonstrating urachal remnant diseases; however, infected urachal cysts commonly display increased echogenicity with ultrasoundsography and thick-walled cystic or mixed attenuation with CT. Drainage and excision of the urachal remnant is the definitive treatment.
PubMed: 31372192
DOI: 10.1016/j.radcr.2019.06.012