PMC10470618_01
A 24-year-old man presented a slightly hypodense mass (red arrows) at the dome of the bladder (A), at arterial phase (B, D, F) and venous phase (C, E, G); contrast-enhanced CT scan showed peripheral enhancement of the mass and no enhancement of necrosis. Coronal (D, E) and sagittal (F, G) images showed the thickened bladder wall (yellow arrows).
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Contrast-enhanced abdominal computed tomography (CT) showed a heterogeneous 2.7 cm x 2.1 cm x 2.1 cm mass at the dome of the bladder ( Figure 1 ).
A 24-year-old man was diagnosed with a primary urachal leiomyosarcoma. Microscopic view showed irregular intersecting bundles of spindle cells with mild cell pleomorphism (A), HE x 600), which indicating a well differentiated leiomyosarcoma. There was necrosis observed in this tumor (B), red star, HE x 200). Some of the nuclei showed atypia (C), red arrows, HE x 400). Some urachal remnants were identified within the tumor tissue that near the abdominal wall side (D), HE x 40), covered with columnar and transitional epithelium cells (D), red square, HE x 400). Immunohistochemical stains showed positivity for desmin (E), x 100) and smooth muscle actin (SMA, (F), x100), compatible with leiomyosarcoma.
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Pathological and immunohistochemical examinations (desmin (+), SMA (+), Bcl-2 (-), MyoD1 (-), myogenin (-), CD117 (-), CD34 (-), DOG1 (-), S100 (-), PHH3 (+, with mitotic activity), Ki-67 (+, 20%)) of the mass confirmed the diagnosis of a leiomyosarcoma originating from the urachus ( Figure 2 ).
Medical timeline of the patient with primary urachal leiomyosarcoma. CT, computed tomography; PET/CT, positron emission tomography/computed tomography.
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The patient was discharged after a week ( Figure 3 ), and no recurrence was noted at one and a half years ( Figure 4 ).
A 24-year-old man was diagnosed with a urachal leiomyosarcoma. One and a half years after surgery, contrast-enhanced CT examination (A-F) showed no recurrence of the tumor.
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The patient was discharged after a week ( Figure 3 ), and no recurrence was noted at one and a half years ( Figure 4 ).