DOI: https://doi.org/10.36347/sjmcr.2025.v13i02.008

Pages: 250-253

Primary urachal adenocarcinoma is an uncommon malignancy arising from the urachus, constituting fewer than 1% of bladder malignancies and posing significant diagnostic and treatment challenges. We present the case of a 41-year-old female patient diagnosed with poorly differentiated tubulovillous adenocarcinoma of the urachus, who had recurrent non-clotting hematuria and urinary tract symptoms. She had surgery and got adjunctive chemotherapy. In November 2021, she received a diagnosis of peritoneal carcinomatosis. She began first-line chemotherapy and maintenance therapy. Regrettably, the patient was not reachable for further evaluation. She was readmitted to the hospital with declining health and passed away five days after admittance. Primary urachal adenocarcinoma (PUA) is an uncommon neoplasm, constituting 0.2% of urinary tract malignancies and 0.01% of all cancers. It manifests in adults, with the peak incidence occurring in the fifth and sixth decades of life. The pathophysiology entails the malignant transformation of urachal leftovers, which are postnatal embryonic structures. Diagnosis is complex and requires a multidisciplinary approach, including imaging, histological evaluation, and radiation. Treatment includes surgical intervention, chemotherapy, radiation, and palliative care. The prognosis is often unfavorable, with a five-year survival rate between 40% and 60%. In conclusion, primary urachal adenocarcinoma (PUA) is an uncommon, aggressive malignancy with a dismal prognosis. Timely identification enhances results; yet, treatment protocols are still insufficient. Future advancement relies on research, early detection techniques, individualized therapies, and heightened clinician awareness.