Ruptured urachal mucinous cystic tumor of low malignant potential: A case report and review of literature

@#Neoplasms of the urachus are uncommon, consisting of only 0.17% of all bladder malignancy. Mucinous cystic tumor of low malignant potential (MCLTMP) is a rare subtype with only 26 cases reported in the literature as of 2023. These tumors may present in a variety of ways such as hematuria, mucusuria, lower abdominal pain and irritative lower urinary tract symptoms. This is a case of 43-year-old female presenting at the emergency room for abdominal pain initially managed as a case of ovarian new growth in complication who underwent exploratory laparotomy, adhesiolysis, bilateral salpingectomy, partial cystectomy enbloc removal of urachal with anterior peritonectomy and excision of umbilicus. Histopathologic examination revealed mucinous cystic tumor of low malignant potential (MCLTMP) of the urachus. It is important to consider the possibility of a ruptured urachal cyst in a female patient who presents with hypogastric abdominal pain. A transabdominal and transvaginal ultrasound may lead to an incorrect diagnosis. In such cases where the patient presented with an acute abdomen, knowledge that a ruptured urachal cyst maybe a differential for such masses would lead to a strategic laparotomy incision aimed at a possible en-bloc removal of the umbilicus while maintaining the connections of the possible urachal mass to the urinary bladder.

Tumor Angiogenesis and the Relationship to the Malignancy Potential in Gastric Carcinomas

Among several factors which have been evaluated for prognostic significance in patients with some types of solid tumors, tumor angiogenesis is reportedly correlated with metastasis, relapse, and prognosis of the tumor. Many studies have suggested that tumor growth is angiogenesis-dependent and that besides an increase in the delivery of nutrients to the tumor cells, this neovascularization also increases the opportunity for tumor cells to enter the circulation, which would imply the importance of tumor angiogenesis to the metastatic potential of tumors. The aim of this study was to investigate the correlation between the degree of angiogenesis and the malignancy potential in gastric carcinomas to determine whether angiogenesis of tumors has prognostic significance. Tumor angiogenesis at the invasive margins of 103 paraffin sections of gastric carcinomas was assessed by a immunohistochemical study by using a monoclonal antibody against the factor-VIII-related antigen and was compared with conventional clinicopathologic factors. In addition, the rate and the mode of recurrence were analyzed according to the degree of angiogenesis. Vessels were immunostained with anti-factor VIII polyclonal antibody, and areas with the most discrete microvessels were counted in a 200xfield, which were defined as angiogenesis score. The angiogenesis score from patients with lymph-node metastasis was significantly higher than that from patients without (P=0.0015). Furthermore, the recurrence rate was significantly greater in the group with higher than the mean angiogenesis score (P=0.004), and according to the pattern of recurrence, angiogenesis of tumors with hematogenous metastasis tended to be greater than that with other types of recurrence (P=0.0002). This retrospective study demonstrates that angiogenesis expressed as an angiogenesis score may be a good prognostic indicator and may be useful as a predictor of recurrence in patients with gastric carcinomas. If these findings are confirmed in larger prospective studies, it might be possible to add the angiogenesis score to the prognostic factors used to identify patients at higher risk for recurrence and to guide in decision for more aggressive adjuvant therapy after surgery.