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Mystery of neck lump: an uncommon presentation of urachal cancer
  1. Kamal Kant Sahu1,
  2. Deepali Pandey1,
  3. Ajay Kumar Mishra1,
  4. James O’Shea2,
  5. Yayan Chen3 and
  6. Bradley McGregor4
  1. 1 Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
  2. 2 Division of Hematology and Medical Oncology, Saint Vincent Hospital, Worcester, Massachusetts, USA
  3. 3 Department of Pathology, Saint Vincent Hospital, Worcester, Massachusetts, USA
  4. 4 Department of Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  1. Correspondence to Dr Kamal Kant Sahu, drkksahu85{at}


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).

  • cancer intervention
  • radiology (diagnostics)
  • malignant disease and immunosuppression
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  • Contributors KKS, photography and paper writing; AKM, conception and design; DP, writing and editing; JO, management and concept; YC, reporting of pathology and discussion; BM, idea and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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