%0 Journal Article %A Kamal Kant Sahu %A Deepali Pandey %A Ajay Kumar Mishra %A James O’Shea %A Yayan Chen %A Bradley McGregor %T Mystery of neck lump: an uncommon presentation of urachal cancer %D 2019 %R 10.1136/bcr-2019-230215 %J BMJ Case Reports %P e230215 %V 12 %N 8 %X 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). %U https://casereports.bmj.com/content/bmjcr/12/8/e230215.full.pdf