PMC6020648_01
Abdominal computed tomographic image taken before systemic chemotherapy, showing (a) a 9-cm mass extending from the bladder to the umbilicus (white arrow) and ((b) and (c)) intraperitoneal nodules (white arrows).
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Contrast-enhanced computed tomography (CT) showed a 9-cm mass extending from the bladder to the umbilicus, along with intraperitoneal nodules suggesting peritoneal dissemination (Figures 1(a), 1(b), and 1(c)).
(a) Abdominal computed tomographic image taken after five cycles of gemcitabine and cisplatin (GC). Abdominal fluid was detected (white arrows). (b) Abdominal computed tomographic image taken after FOLFIRI (l-leucovorin + 5-fluorouracil + irinotecan). The tumor size had decreased to 7 cm (white arrow).
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However, after five cycles, his CEA concentration had increased to 8.3 ng/mL and his CA19-9 concentration had also increased to 304.1 ng/mL with a CT scan showing changes in the tumor and the appearance of abdominal fluid (Figure 2(a)). After 11 cycles of FOLFIRI, serum tumor marker levels had not changed markedly, but a CT scan showed a reduction in tumor size to 7 cm (Figure 2(b)) and no new distant metastases.
(a) and (b) show surgical specimen of the urachal carcinoma. The tumor was removed, along with surrounding adherent organs, including the omentum, peritoneum, and bladder dome. Disseminated nodules were detected in the omentum. (c) and (d) show cords of adenocarcinoma cells in abundant mucin (H&E stain).
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Cytology showed that the mucinous fluid in the abdominal cavity was class V and the final pathological diagnosis was urachal mucinous adenocarcinoma with invasion of the omentum and peritoneal dissemination (Figure 3).
Serum tumor marker concentrations. Serum concentrations of carbohydrate antigen 19-9 (CA19-9; orange line) and carcinoembryonic antigen (CEA; blue line) were high during chemotherapy but normalized dramatically after surgery, with no significant increase detected to date.
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Although he showed a slight increase in serum CEA level to 6.3 ng/mL, his serum CA19-9 level remained within normal limits (Figure 4), and no radiological recurrence has been detected.