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Browsing by Author "Isisag, A"

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Anaplastic Ependymoma and Atypical Refractory Longitudinal Expansive Transverse Myelitis Due to Immune Reaction After COVID-19-A Case Discussion That Raises Many Unknown Questions About Covid-19
Gemici, YI; Çelik, F; Göz, ZZ; Isisag, A; Ovali, GY; Zileli, M; Barutçuoglu, M; Mavioglu, H
Inflammatory neurologic manifestations, both infectious and noninfectious, have been reported secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19). However, the relationship of spinal tumor and COVID-19 longitudinally extensive transverse myelitis (LETM) coexistence has never been reported in our knowledge. The clinical presentation and response to treatment of a 24-year-old female patient diagnosed with COVID-19 LETM and anaplastic ependymoma are described in this case report. The Patient's cerebrospinal fluid COVID-19 antibody level was higher than serum , she was resistant to immunosuppressive treatment. The interaction between COVID-19 and spinal tumor was discussed in the light of the literature. It is thought that COVID-19 infection could trigger tumor growth in this patient. Also, this is the first case of anaplastic ependymoma and COVID-19 myelitis coexistence in the literature.
Midede Dev Hiperplastik Polip
Duman, FU; Ayhan, S; Isisag, A; Yaman, I
Hyperplastic polyps, which account for nearly 75% of all gastric polyps, are generally small (< 1 cm), single, sessile, polyps and located in antrum. They are usually asymptomatic. A 77-year-old man was admitted to hospital due to severe fatigue as a consequence of iron-deficiency anemia. The upper gastrointestinal endoscopy which was done to discover an etiological factor revealed a papillomatous mass 6 cm in diameter that had a malignant endoscopic appearance. Numerous macroscopic sections were taken since larger gastric polyps (especially those greater than 2 cm in diameter) have a greater risk of malignancy development. No dysplasia was detected on histological and immunohistochemical evaluation and it was therefore diagnosed as a giant hyperplastic polyp in the stomach. The large size of the polyp in the presented case led us to emphasize the importance of searching for dysplasia in such cases.
Col IV and Fn distribution in prostatic adenocarcinoma and correlation of 67LR, MMP-9 and TIMP-1 expression with Gleason score
Isisag, A; Nese, N; Ermete, M; Lekili, M; Ayhan, S; Kandiloglu, AR
OBJECTIVE: To assess the immunoreactivity of 5 proteins related to basement membrane (BM) and extracellular matrix in order to investigate whether any of them correlates with differentiation of prostatic adenocarcinoma (PAc). Two of these markers are collagen type IV (Col IV), the collagenous component of basement membrane, andfibronectin (Fn), an adhesion protein in extracellular matrix. Others are matrix metalloproteinase-9 (MMP9), a type IV collagenase, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), which has a high affinity for A4MP-9, and 67-kd laminin receptor (67LR), which belongs to the non-integrin laminin binding receptor family. STUDY DESIGN: Forty-three PAc cases with Gleason scores ranging between 5 and 10 and 10 benign prostatic hyperplasia (BPH) cases, the control group, were included in the study. Formalin-fixed and paraffin-embedded tissue slides from each case were immunostained with the avidin-biotin-peroxidase method. Immunoreactivity was determined by means of a scoring system similar to the Gleason scoring system. RESULTS: Overexpression of Col IV, Fn, 67LR and MMP-9 was detected in PAc as compared with BPH, whereas no difference was determined in TIMP-1 expression. Among these, only 67LR correlated statistically with Gleason score. CONCLUSION: Expression of 67LR in tumor cells was significantly increased in parallel to tumor grade. This may be useful in microscopic evaluation of PAc.
Sonic hedgehog, TBX18, and TSHZ3 proteins involved in pyeloureteral motility development are overexpressed in ureteropelvic junction obstruction An immunohistochemical, histopathological, and clinical comparative study
Yilmaz, O; Nese, N; Dalgic, M; Kesici, GP; Genc, A; Taneli, C; Gunsar, C; Sencan, A; Cayirli, H; Isisag, A
Objectives: To compare pathological samples obtained from cases that underwent surgery for ureteropelvic junction (UPJ) obstruction with samples obtained during autopsies of subjects. Methods: Retrospectively, 42 patients who had undergone surgery due to UPJ obstruction (group 1) were included in the study. Histopathological and immunohistochemical features for sonic hedgehog (SHH), TBX18, and TSHZ3 of UPJ were evaluated and findings were compared with 20 autopsy cases (group 2). Results: In group 1, the scores were statistically significantly higher in terms of cytoplasmic SHH, nuclear TBX18, cytoplasmic and nuclear TSHZ3 staining. Statistically, no correlation was found between age and the staining scores belonging to these 3 antibodies in group 1 and group 2. Intense inflammation was found to be related with nuclear staining for TBX18. Conclusion: Gene product expressions of SHH, TBX18 and TSHZ3 are statistically higher in patients with UPJ obstruction, when compared with control group. The explanation may be the reactivation of the processes, which had shown their effects in the embryological period, due to the chronic inflammation and long-term micro-trauma created by the disease.
Relationship of Tumor-Associated Macrophage Population Detected by CD68 PG-M1, CD68 KP1, and CD163 with Latent EBV Infection and Prognosis in Classical Hodgkin Lymphoma
Mavili, HS; Isisag, A; Tan, A; Miskioglu, M; Saka Baraz, L; Nese, N
Objective: To evaluate the quantity of tumor-associated macrophages (TAMs) in cases of Hodgkin Lymphoma of classical type (cHL), and to reveal possible associations between TAM intensity and latent Epstein-Barr virus (EBV) infection, overall survival, progression-free survival, prognostic indices, and clinicopathological parameters. Materials and Methods: A total 46 cases of cHL with complete clinical records were selected and re-evaluated histopathologically. Staining for CD68 (PG-M1; KP1 clones) and CD163 was evaluated and the cut-off values were defined. Also, all cases were evaluated using the chromogen in situ hybridization (CISH) method with EBER (Epstein-Barr virus-encoded RNA) probes for the presence of possible EBV infection. Results: It was found that high expression levels of PG-M1 and high International Prognostic Scores (IPS) were associated with shortened overall survival (p=0.047, p=0.013). Cases with 2 or less areas of nodal region involvement were observed to have longer progression-free survival period (p=0.043). Higher expression levels of CD68 PG-M1, CD68 KP1, and CD163 were found to show significant associations with the presence of some clinical parameters such as the presence of B symptoms, spleen involvement, and the presence of EBV infection. Conclusions: Our findings suggest that increase of PG-M1+ TAM is associated with shortened overall survival, while higher expressions of all immunohistochemical markers are statistically significantly associated with the presence of EBV infection and clinical parameters mentioned above. These findings indicate that highlighting the TAM rate via macrophage markers in cases of cHL could be helpful in determining the prognostic risk groups and the relevant results should be mentioned in pathology reports.
The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis
Göktalay, T; Çelik, P; Alpaydin, AÖ; Havlucu, Y; Coskun, AS; Isisag, A; Yorgancioglu, A
OBJECTIVES: This study aimed to investigate the additional diagnostic value of endobronchial biopsy (EBB) in the diagnosis of pulmonary sarcoidosis. MATERIALS AND METHODS: This retrospective cross-sectional study included 59 patients with a preliminary diagnosis of sarcoidosis who were admitted to the Pulmonary Diseases Outpatient Clinic of a tertiary healthcare center between January 2005 and October 2012. The socio-demographic characteristics of the patients as well as clinical and radiological findings were recorded. All patients, irrespective of the presence of an endobronchial lesion (EBL), underwent fiberoptic bronchoscopy (FOB); two to four specimens were taken using EBB from the carina of the right middle lobe in the patients with EBL. RESULTS: Of the patients, 39 (66.1%) had normal bronchoscopic findings, while 5 had EBL. Diagnosis was based on EBB in 11 patients (18.6%). Six patients (15.3%) with normal bronchial mucosae were pathologically diagnosed by EBB. There was no statistically significant relationship between the diagnostic ratio of EBB and disease stage, extrapulmonary involvement, FOB findings, elevated lymphocyte rate in bronchoalveolar lavage (>= 13%), a CD4/CD8 ratio of >= 3.5, and serum angiotensin-converting enzyme (ACE) level (p > 0.05). CONCLUSION: EBB not only offers the advantage of a high diagnostic ratio in patients with mucosal abnormalities but also contributes to pathological diagnosis in patients with normal mucosa. We recommend using EBB to support diagnosis with a low complication rate for patients undergoing FOB with a preliminary diagnosis of sarcoidosis in healthcare centers, where endobronchial ultrasound (EBUS) is unavailable.
The systemic cellular immune response in the Helicobacter pylori-associated duodenal ulcer and chronic antral gastritis
Yuceyar, H; Saruc, M; Kokuludag, A; Terzioglu, E; Goksel, G; Isisag, A
Background/Aims: The exact pathogenesis of Helicobacter pylori infection is not fully understood. This study aims to evaluate the specific subset composition of peripheral blood lymphocytes in patients with H. pylori-positive duodenal ulcer n=14), chronic antral gastritis n=28), since reports so far have led to inconclusive and conflicting results. Methodology: 42 patients with dyspepsia and 50 controls underwent the following procedures: 1) gastroscopy and gastric biopsy (five specimens) 2) histology, 3) serologic test for anti-H. pylori antibodies IgG (Pyloriset EIA-G, Orion Diagnostica) and anti-cytotoxin associated gene A (cag A) IgG antibodies (VIVA Diagnositika by ELISA), 4) analysis of the peripheral blood lymphocytes using monoclonal antibodies reacting with lymphocyte cell surface antigens (anti-CD3, anti-CD19, anti-CD4, anti-CD8, anti-CD16 + CD56, anti-HLA DR) by flow-cytometry (Becton-Dickinson) to detect possible changes in the lymphocytes subpopulation in patients with duodenal ulcer and chronic antral gastritis. Results: We found no alteration in total T and B lymphocytes and CD4(+) T, CD8(+) T lymphocytes and natural killer cells of both duodenal ulcer and chronic antral gastritis patients compared to normal persons. although there was a slight increase in the proportion of active T lymphocytes in duodenal ulcer and chronic antral gastritis groups comparing to healthy subjects the difference was not statistically significant. Conclusions: These data indicate that there is no systemic alteration in the specific immune system in response to H. pylori in patients with duodenal ulcer and chronic antral gastritis.
The Role of pRB, p16 and Cyclin D1 in Colonic Carcinogenesis
Ayhan, S; Isisag, A; Saruc, M; Nese, N; Demir, MA; Kucukmetin, NT
Background/ Aims: This study is aimed to investigate abnormal expression of the Rb protein (pRb), p16(INK4n) (p16) and cyclin D1 in colorectal adenomas and adenocarcinomas and to assess the possible alterations in Rb pathway in colorectal carcinogenesis. METHODOLOGY: 44 cases of colorectal adenoma and 44 cases of colorectal adenocarcinoma were examined histopathologically and immunohistochemically using monoclonal antibodies to identify abnormalities of pRb, p16, and cyclin D1 expression. Staining degree of above-mentioned markers was assessed by using a semi-quantitative method in all cases in order to determine any staining differences. RESULTS: In 70.5% of the adenomas and 97.7% of the adenocarcinomas, an overexpression of pRb was found. There was a statistically significant relationship between the immunoreactivity of pRb and villous/ tubulovillous types of adenomas (p<0.05). There was a loss of p16 expression in 84.1% of adenomas and 61.4% of adenocarcinomas. Statistically significantly, the p16 overexpression was not seen in any of tubular adenomas (p<0.001). Overexpression of cyclin D1 was found in only 9.1% of adenomas, while 31.8% of adenocarcinomas overexpressed this protein. Loss of expression of cyclin D1 was similar in adenomas and adenocarcinomas (27.3% and 25%, respectively). Staining degrees of all three cell cycle proteins were shown to be statistically different in adenomas and adenocarcinomas, for pRb (p=0.001), for p16 (p=0.045), and cyclin D1 (p=0.05). Also, there was only a mild agreement with respect to p16 and cyclin D1 relationship between for adenomas (k=+0,28 p=0,051) and for adenocarcinomas (k=+0,35 p=0,017). Besides, there was no correlation between the expression of pRb, p16, and cyclin D1 and clinicopathological tumor characteristics and prognostic data such as stage or lymph node/liver metastasis. CONCLUSIONS: pRb, p16 and cyclin D1 are shown to be aberrantly expressed in both colorectal adenomas and adenocarcinomas. It can be claimed that disturbances in Rb pathway take part in colonic carcinogenesis and pRb, p16 and cyclin D1 play an ever increasing role in the further stages of adenoma-carcinoma sequence.
Immunohistochemical analysis of Ki-67, p53 and Bcl-2 expression related to histological features in gastroesophageal reflux disease
Ayhan, S; Nalbant, OA; Isisag, A; Küçükmentin, NT; Temiz, P
Background/aims: The endoscopic and histologic findings of gastroesophageal reflux disease are usually indistinct. The current study was designed to define accurately the histology in gastroesophageal reflux disease and to develop a hypothesis that reflux produces immunohistochemical changes. Methods: The study was based on the examination of endoscopic esophageal biopsy specimens obtained from 20 patients with evidence of reflux with 24-hour pH-meter monitoring and from 20 control subjects without clinical or endoscopic reflux. The pathogenesis of reflux esophagitis was discussed by comparing the histopathologic changes with determined Ki-67, p53 and Bcl-2 immunoreactivity. Results: In this study, the presence of esophagitis was determined endoscopically in only 55% of the patients with gastroesophageal reflux disease, while microscopic esophagitis was detected in 60% of them. No correlation was found between presence of endoscopic esophagitis and microscopic esophagitis in the patients with gastroesophageal reflux disease. There was a significant difference between control cases and the patients according to histological parameters, which included basal activity (p=0.006), height of papillae (p=0.006), intraepithelial neutrophils (p=0.000), intraepithelial eosinophils (p=0.006), congestion (p=0.001), and dilated intercellular spaces (p=0.006). Immunohistochemically, there was a significant difference in the expression of p53 and Ki-67 between the three study groups (patients with I without microscopic esophagitis, controls) (p<0.05). However, there was no difference in Bcl-2 between the patients with reflux and control cases. Conclusions: In this study, we considered that microscopic esophagitis does not always accompany reflux, and the lack of reliable diagnostic histologic criteria is still a serious problem for pathologists. Immunohistochemically, an increase in cell proliferative activity and p53 protein accumulation to repair oxidative DNA damage related to reflux were observed. However, the close Bcl-2 immunoreactivity in all groups that was indicated by a weak positivity suggests that the inhibition of apoptosis may not be involved in reflux esophagitis.
Effects of extracorporeal shockwave lithotripsy at different stages of pregnancy in the rabbit
Gumus, B; Lekili, M; Kandiloglu, AR; Isisag, A; Temeltas, G; Nazli, O; Buyuksu, C
Although SWL is now the most common treatment modality for urinary tract stone disease, it is not regarded as a safe method for pregnant patients because of its potential harmful effects on fetus, Using a rabbit model, Re investigated whether SWL might cause fetal injury when administered at various developmental stages. Two groups of pregnant rabbits were given 1000 shockwaves either early or late in the gestational period, Time-matched controls did not receive shockwaves, After spontaneous labor, all newborn rabbits were counted, weighted, and measured, and specimens were taken from organs and examined histopathologically. The numbers, weights, and diameters of the newborns in each group were similar, There was no notable histopathologic finding in the heart and brain specimens of any of the newborns, whereas noticeable congestion and multiple focal intraparanchymal microhemorrhages were found in lungs, livers, and kidneys of the animals that had been exposed to shockwaves early in gestation, In conclusion, this study shows that SWL is not a safe treatment in early pregnancy.
Splenic Hamartoma
Nalbant, OAK; Nese, N; Kahya, M; Isisag, A
Splenic hamartoma is a rare, benign lesion of the spleen requiring differential diagnosis. A 60-year-old male patient referred to the hospital with epigastric pain. Abdominal computed tomography revealed a mass in the spleen and multiple lymphadenopathies at the posterior wall of the stomach. The patient underwent splenectomy for diagnostic purposes. A pink to red, solid, well circumscribed tumoral lesion with a greatest diameter of 4.5 cm was observed on the cut surface of the splenectomy specimen in addition to ten other, not well circumscribed, dark red, solid tumoral lesions measuring between 0,3-1 cm in greatest diameter. All of the lesions were diagnosed as splenic hamartoma. As splenic hamartoma is a rare lesion and needs to be di + erentiated from other benign tumoral lesions of the spleen, this case is found worth to be presented.
Histological discrepancies in malignant glioneuronal tumors: A report of 4 cases
Isisag, A; Nese, N; Demirtas, E; Tunakan, M; Rezanko, T; Temiz, C; Mirzai, H
Thyroidal angiogenesis in zebrafish (Danio rerio) exposed to high perchlorate concentration
Üçüncü, SI; Karayazi, Ö; Isisag, A
As a well known environmental contaminant, perchlorate inhibits thyroidal iodide uptake and reduces thyroid hormone levels. In zebrafish (Danio rerio) exposed to high concentrations of sodium perchlorate (200, 350 and 500 mg/L) for 10 days, remarkable angiogenesis was identified, not only histopathologically but also statistically by counting of the small, medium and large sized (grades 1 to 3) vessels per unit area. Angiogenic response is concluded as the most sensitive parameter for rating of high concentrations of perchlorate exposure.
Pleural Giant Solitary Fibrous Tumor and Immunohistochemical Profile
Nese, N; Yaldiz, S; Ovali, G; Isisag, A
Pleural solitary brous tumor is a rare and slow growing intrathoracic neoplasm. It originates from submesenchymal cells of parietal or, more commonly, visceral pleura. Although most cases follow a benign clinical course, it has been reported that a malignant outcome is seen in 7,5-37% of cases. We present here a case considered as pleural solitary brous tumor with malignant potential. A 74-yearold woman presented with dyspnea and computerized tomography showed a mediastinal mass connected to the pleura. The tumor was removed by surgery. Grossly, the tumor was lobulated, welldemarcated and mostly encapsulated. Its weight was 754 gr. and it measured 17x12x5.5 cm. The cut surface had a whorled appearance. Focal necrosis and myxoid degenerative areas were noted. Histopathologically, hypocellular areas characterized by uniform, small spindle cells in a collagen rich stroma and hypercellular areas were seen. The tumor had a prominent branching vascular network. Although mitosis was infrequent, necrosis was common. Tumoral cells were strongly immunoreactive for CD34, bcl-2 and vimentin by immunohistochemistry. Cytokeratin, actin, S100, CD117 and desmin were negative. The ratio of Ki-67 positive cells was 10%. the patient was diagnosed as pleural solitary brous tumor with malignant potential because of hypercellularity and presence of large necrotic areas although increased mitosis and pleomorphism were almost absent. : ere was no recurrence or metastasis 15 months after the surgery.
Isolated Solitary Intramedullary Spinal Cord Metastasis Presenting as the First Manifestation of Small-Cell Lung Cancer: Report of a Rare Case
Duransoy, YK; Mete, M; Selçuki, M; Isisag, A
Background. Intramedullary spinal cord metastases presenting as the first manifestation of malignancies are extremely rare lesions. Case Description. The authors report a 74-year-old woman who presented with an isolated intramedullary spinal cord metastasis which presents as first manifestation of malignancy without central nervous system and/or other organ involvement. She went under surgery, and after histopathological evaluation, primary focus was determined in lung in positron emission tomography. She is still alive after 9 months since the first diagnosis of primary focus. Conclusion. In patients with solitary intramedullary lesion in the spinal magnetic resonance imaging, whole-body investigation might help for diagnosis of primary focus and approach to treatment.
Does asthma control as assessed by the asthma control test reflect airway inflammation?
Bora, M; Alpaydin, AO; Yorgancioglu, A; Akkas, G; Isisag, A; Coskun, AS; Celik, P
Background and aims: The treatment of asthmatic patients is particularly focused on the control of symptoms as well as functional and inflammatory parameters. In our study, we investigated the relationship between the asthma control test (ACT) which evaluates symptoms and airway inflammation and functional parameters. Materials and methods: Stable asthmatic patients admitted to our pulmonary outpatient clinic were enrolled in the study consecutively and underwent the ACT, pulmonary function tests and methacholine bronchial provocation test (MBPT). Additionally, fractional exhaled nitric oxide level (FeNO) and induced sputum cell distribution were assessed. All these parameters were re-evaluated at the third month after adjusting medications of the patients according to baseline ACT scores. Results: Of the 101 patients screened, we analyzed 83 who proceeded to the follow up visit. At the baseline visit, 8 were totally controlled, 36 partially controlled and 39 uncontrolled according to ACT. At the follow up visit, 10 were totally controlled, 39 partially controlled and 34 uncontrolled. Comparison of the two visits in terms of all parameters revealed significant reductions only in the percentages of patients with MBPT positivity (p = 0.029) and FeNO levels > 20 ppb (p = 0.025) at follow up. The percentages of patients with FeNO > 20 ppb, MBPT positivity, induced sputum eosinophilia or induced sputum neutrophilia did not show significant differences between totally controlled, partially controlled and uncontrolled groups at both baseline and follow up visits. Conclusion: Although the ACT scores did not show significant correlations with the airway inflammation parameters tested in this study, a marked reduction in the percentage of patients with MBPT positivity and FeNO > 20 ppb at follow up may suggest the importance of the control concept in the management of asthma.
A thymic neuroendocrine carcinoma presenting with upper gastrointestinal bleeding: A case report
Yaldiz, S; Yaldiz, D; Tulay, CM; Isisag, A
Neuroendocrine carcinomas of the thymus are rare clinical entities, which can be complicated by endocrine abnormalities. These tumors are frequently associated with ectopic adrenocorticotropic hormone production giving rise to Cushing's syndrome. Herein, we describe a 23-year-old male case with upper gastrointestinal bleeding as the initial presentation of a thymic neuroendocrine carcinoma. This case was reported due to its extremely exceptional occurrence.
Hairy Cell Leukemia and cutaneous involvement
Ergene, Ü; Özbalci, D; Isisag, A
Lower Airway Inflammation in Nonasthmatic Allergic Rhinitis Patients
Alpaydin, AÖ; Bora, M; Günhan, K; Isisag, A; Çelik, O; Çelik, P; Taneli, F; Yorgancioglu, A
Objective: Allergic rhinitis and asthma have been considered as a single airway disease sharing a common pathophysiological mechanism of airway inflammation. We aimed to investigate the lower airway inflammation in allergic rhinitis patients without asthma. Material and Methods: Forty patients who referred to our tertiary care hospital's otorhinolaryngology clinic and diagnosed as moderate/severe persistent allergic rhinitis according to ARIA criteria were included in the study. After evaluation for the eligibility for the study, a nasal smear was taken, and rhinomanometry was performed to measure the nasal obstruction on visit 1. Twenty-four hours later from the visit 1, pulmonary functions including bronchial hyperactivity (BHR) were measured on visit 2. Twenty-four hours later from the visit 2, sputum induction was performed, and cell distribution of the sputums was evaluated. Results: Mean age of the 17 male and 23 female patients was 37 +/- 11. Nasal smear eosinophilia was studied in 36 of the patients and found positive in 36%. Nasal obstruction was demonstrated in 68% of the patients by rhinomanometry. BHR was positive in 30% of the participants. There was not any statistical significant relationship between nasal eosinophilia and nasal obstruction severity, BHR and induced sputum eosinophilia (p> 0.05). Among the induced sputums which were of good quality to be evaluated, 7.5% had an eosinophil ratio of 2%. Any relationship between induced sputum eosinophil percentages and FEV1, FEV1/FVC, nasal obstruction severity was not observed (p> 0.05). However, BHR was found to be significantly related with FEV1/FVC ratio which was >70% through the whole study population (r= 0.392 p= 0.012). Condusion: We could not demonstrate the expected relationship between nasal and lower airway inflammation markers in our study group of allergic rhinitis patients. This may be due to the small number of study population and strict exclusion of asthmatic patients as well as particularly the difficulties in standardization of the induced sputum technique.
Urachal Urothelial Carcinoma Diagnosed at a Radical Prostatectomy Operation A Case Report
Nese, N; Kesici, G; Lekili, M; Isisag, A
BACKGROUND: Urachal carcinomas are rare tumors, and the majority of them are adenocarcinomas. Up to now, only 21. urachal urothelial carcinomas (UCas) have been reported. Here, we describe a case of high grade UCa arising from the urachal remnants. CASE: A 66-year-old man presented with voiding difficulties. Prostate specific antigen (PSA) was 5.46 ng/mL. Prostatic adenocarcinoma (PCa) (Gleason score 6) was diagnosed by needle biopsies. After the diagnosis of high grade, muscle invasive UCa with intact mucosa on frozen examination of the dome of bladder wall during the radical prostatectomy operation (RPO), partial cystectomy was performed. Microscopically, among the tumoral islands, cystic structures lined by cells with a benign appearance, which are considered urachal remnants, were noted. Cytokeratin 7 and high-molecular-weight cytokeratin were strongly positive, PSA and carcinoembryonic antigen were negative. Radiotherapy was given for both UCa and PCa. Six months after the diagnosis, an undifferentiated tumor was detected in a bladder transurethral resection specimen; thus, chemotherapy was given.. After 1 course of chemotherapy, the patient was doing well. CONCLUSION: The origin of urachal carcinomas is usually obscured as it is a highly invasive carcinoma. The patient presented here was diagnosed incidentally during RPO. Although the stage was advanced, the tumor was detected before urachal remnants were destroyed. The treatment choice for urachal carcinomas is cystectomy. Adjuvant chemotherapy and radiotherapy are controversial. (Anal Quant Cytol Histol 2010;32:174-177)

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