LAUSR

An 85-year-old man presented to the emergency department with a large, painless, ulcerated, haemorrhagic periumbilical mass. It had been slowly growing over the previous 2 years without causing any significant bleeding. He complained about fatigue, poor appetite and weight loss of >10 kg over the last 6 months. He was receiving medication for hypertension. His past medical and surgical history were otherwise unremarkable. On examination, he was haemodynamically stable and malnourished with a profound infraumbilical ulcerated haemorrhagic mass. The mass had the appearance of the Cyclops’ eye (Fig. 1a). On palpation, the mass seemed to be fixed on the abdominal wall, while there was slight tenderness over the hypogastrium. Laboratory tests revealed mild anaemia, slightly elevated serum urea and creatinine levels. He underwent an abdomen and chest computed tomography scan, which showed a 10-cm mass, with characteristics of nonhomogeneous soft structures located to the anterior abdominal wall, in the umbilical region. The mass was involving the adjacent portion of the rectus abdominis muscle and adipose tissue (Fig. 1b). There were no regional or distant enlarged lymph nodes. He underwent exploratory laparotomy and wide tumour excision. Figure 2 shows the surgical specimen. There was no intraabdominal or bladder-related disease. The abdominal wall deficit left after the excision was bridged with a biomesh, which was sufficiently covered by the abdominal wall skin. The pathology examination showed a low differentiation urothelial carcinoma of 10 × 8 × 8 cm, invading the spindle muscle fibres of the abdominal wall. Necrotic and haemorrhagic regions, as well as lymphatic and microvascular tumour infiltration, were evident (Fig. 3). The surgical margins were clear. The patient had an uneventful recovery and was discharged on the fourth postoperative day. He received no further treatment and was recovering