Dramatic regression of an inflammatory urachal pseudotumor mimicking adenocarcinoma under conservative medical therapy

Inflammatory pseudotumors (IPTs) are rare benign lesions that often mimic malignancy, posing diagnostic and therapeutic challenges, especially in uncommon sites such as the urachus. We report a 66-year-old woman with a firm peri-umbilical mass initially suggestive of invasive urachal adenocarcinoma. Despite aggressive imaging features, biopsy revealed fibro-inflammatory tissue without neoplasia. The lesion regressed almost completely under antibiotics and anti-inflammatory therapy, with sustained remission. This case illustrates that IPTs, even when radiologically aggressive, may respond to conservative management, underscoring the importance of multidisciplinary evaluation and follow-up to avoid unnecessary radical surgery.