The patient was a 56-year-old male, with no personal history of interest, who consulted for self-limiting episodes of macroscopic monosymptomatic hematuria of 2 months duration.
At rectal examination, the prostate was well delimited and had adenomatous consistency (grade II/IV).
The complementary examinations performed were as follows:
- complete blood count, biochemistry, urine cytology and sediment: within normal limits.
PSA: 1.46 ng/ml.
- Urological ultrasound: bilateral renal sinus cysts.
Normal bladder.
- Intravenous urography: foot-and-mouth disease caused by the aforementioned cysts
Permeable ureters.
Normal bladder.
The presence of a 'contrast drain' into the abdominal cavity stood out in the post-voiding plaque.
- cystoscopy: a small solid mass in the bladder dome.
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These findings underwent transurethral resection (TUR) of the lesion, with the histopathological result of adenocarcinoma arising from the bladder wall.
After this diagnosis, an extension study was performed by chest X-ray (which is reported as normal) and TAC is also reported as a persistent peritoneal wall located in the pelvic wall where the tubular structure extending from the bladder dome to the bladder cancer.
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One week before the definitive surgical treatment, the patient was admitted for high fever accompanied by voiding symptoms, abdominal pain, vomiting and anorexia.
On physical examination, the patient presented abdominal distension with some degree of peritoneal irritation.
Laboratory tests revealed leukocytosis with neutrophilia.
After introducing broad-spectrum parenteral antibiotic treatment, the patient improved with the exception of abdominal distension.
Abdominal ultrasound showed a large amount of ascitic fluid with septa inside.
With the suspected diagnosis of urachus, a wide partial cystectomy was performed, including the bladder dome, large mass of urachus and adenocarcinoma, in addition to pelvic lymphadenectomy.
During surgery, a large amount of mucoid material was observed throughout the peritoneal cavity (several samples were taken from different locations for histological study).
The anatomopathological diagnosis of the surgical specimen was mucinous adenocarcinoma of the urachus extending to the urinary bladder and peritoneum.
The histological report of the mucoid material sent was peritoneal pseudomyxoma.
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Currently, after 1 year of follow-up, the patient is asymptomatic and with disease-free extension study.
