Mystery of neck lump: an uncommon presentation of urachal cancer

Kamal Kant Sahu; Deepali Pandey; Ajay Kumar Mishra; James O'Shea; Yayan Chen; Bradley McGregor

doi:10.1136/bcr-2019-230215

Mystery of neck lump: an uncommon presentation of urachal cancer

BMJ Case Rep. 2019 Aug 26;12(8):e230215. doi: 10.1136/bcr-2019-230215.

Authors

Kamal Kant Sahu¹, Deepali Pandey¹, Ajay Kumar Mishra¹, James O'Shea², Yayan Chen³, Bradley McGregor⁴

Affiliations

¹ Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
² Division of Hematology and Medical Oncology, Saint Vincent Hospital, Worcester, Massachusetts, USA.
³ Department of Pathology, Saint Vincent Hospital, Worcester, Massachusetts, USA.
⁴ Department of Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.

Abstract

We present the case of a 55-year-old male patient who presented with palpable cervical lymphadenopathy. Excisional biopsy showed metastatic adenocarcinoma of unknown origin. Imaging showed a bladder mass following which he underwent transurethral resection of bladder tumour. Histopathological evaluation of mass confirmed a poorly differentiated adenocarcinoma with signet-ring cell features. Immunohistochemistry was suggestive of metastatic urachal cancer. He agreed for enrollment in a clinical trial, however soon after 1st cycle, he developed immune pneumonitis requiring high dose steroids. On follow-up, MRI brain was done for evaluation of headache which showed metastatic intracranial disease. He completed radiotherapy following which he was started on FOLFOX chemo regimen (folinic acid, 5-fluorouracil and oxaliplatin).

Keywords: cancer intervention; malignant disease and immunosuppression; radiology (diagnostics).

Publication types

Case Reports

MeSH terms

Adenocarcinoma* / immunology
Adenocarcinoma* / pathology
Adenocarcinoma* / therapy
Antineoplastic Combined Chemotherapy Protocols* / administration & dosage
Antineoplastic Combined Chemotherapy Protocols* / adverse effects
Biopsy / methods
Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / pathology
Brain Neoplasms* / secondary
Diagnosis, Differential
Fluorouracil / administration & dosage
Fluorouracil / adverse effects
Humans
Immunohistochemistry
Immunosuppressive Agents / administration & dosage
Immunosuppressive Agents / adverse effects
Leucovorin / administration & dosage
Leucovorin / adverse effects
Lymph Nodes / pathology*
Lymphatic Metastasis* / pathology
Lymphatic Metastasis* / therapy
Magnetic Resonance Imaging / methods
Male
Middle Aged
Neck
Neoplasm Staging
Organoplatinum Compounds / administration & dosage
Organoplatinum Compounds / adverse effects
Radiotherapy / methods*
Urinary Bladder Neoplasms* / immunology
Urinary Bladder Neoplasms* / pathology
Urinary Bladder Neoplasms* / therapy

Substances

Immunosuppressive Agents
Organoplatinum Compounds
Leucovorin
Fluorouracil

Supplementary concepts

Folfox protocol
Urachal cancer