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Binsaeedu AS, Bin Saeedu SS, Bamashmos AS. Low-grade papillary urothelial neoplasm: A case report study. Radiol Case Rep 2023; 18:2895-2899. [PMID: 37388533 PMCID: PMC10300251 DOI: 10.1016/j.radcr.2023.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
Urothelial carcinoma (UC) of the bladder is a prevalent malignant tumor among the elderly, whereas its incidence is scarce in the first 2 decades of life. The most commonly reported symptom in the literature is isolated hematuria, frequently overlooked during the initial medical assessment. In this study, we present the case of a 3-year-old male with hematuria, accompanied by other irritative symptoms such as flank pain, nausea, and vomiting. Ultrasonography revealed a bladder mass, which was later confirmed to be a noninvasive low-grade papillary urothelial carcinoma (NLPUC) through histopathological examination. This report discusses the clinical and pathological characteristics of the case and examines current literature on the topic.
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Affiliation(s)
- Abdullah S. Binsaeedu
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Suaad Salah Bin Saeedu
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Anas Saeed Bamashmos
- Department of Radiology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, USA
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2
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Xu K, Tian C, Liu Y, Wu K, Jiao D, Han X. Is iodine-125 seed strand brachytherapy suitable for ureteral carcinoma? Urol Oncol 2022; 40:537.e11-537.e17. [PMID: 36216664 DOI: 10.1016/j.urolonc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/15/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term conventional high-dose radiation therapy can lead to retroperitoneal fibrosis and nerve damage in patients with advanced ureteral carcinoma (UC). The purpose of this study is to evaluate the safety and efficacy of nephrostomy combined with iodine-125 seed strand (ISS) brachytherapy for the treatment of UC. MATERIALS AND METHODS Twenty-one patients with UC were treated with nephrostomy combined with ISS brachytherapy. The following parameters were recorded: technical success rate, procedure time, complications, mean D90 (dose delivered to the 90% gross tumor volume), organ at risk (OAR) dose, local control rate (LCR), ureteral patency (UP), local tumor progression (LTP), and overall survival (OS). The hydronephrosis score (HS), visual analog score (VAS), Karnofsky score and maximum diameter (MD) were compared before and 8 weeks after the operation. RESULTS The technical success rate was 100%, with a mean procedure time of 54.6 min. Three cases (14.5%) had bladder implant metastasis but no other major complications, such as ureteral perforation, infection, or severe bleeding, occurred. The mean D90 and OAR doses were 50.7 and 3.8 Gy, respectively. LCR was 100% with 28.6% UP at the 8-week evaluation. During the mean follow-up of 16.6 months, LTP occurred in 4 cases (19.1%), and the median OS was 25.0 months (95% CI 21.3-28.5). The HS, VAS, Karnofsky score and MD showed significant changes (all P < 0.01). CONCLUSION UC can be safely and effectively treated by nephrostomy combined with ISS brachytherapy, a viable option for patients who cannot undergo or refuse surgical resection.
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Affiliation(s)
- Kaihao Xu
- Department of Interventional Radiology, the First affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chuan Tian
- Department of Interventional Radiology, the First affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Liu
- Department of Interventional Radiology, the First affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kunpeng Wu
- Department of Interventional Radiology, the First affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dechao Jiao
- Department of Interventional Radiology, the First affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Xinwei Han
- Department of Interventional Radiology, the First affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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3
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González-Arboleda AA, Fernandez N, García-Perdomo HA. Genitourinary Tract Tumors in Children: An Update. Curr Pediatr Rev 2022; 18:166-178. [PMID: 35021978 DOI: 10.2174/1573396318666220111143902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/17/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Genitourinary tract tumors in children are less common than in adults. Most of these tumors have different genetic backgrounds, clinical presentation, and oncologic behavior than their adult counterpart. As a result of low prevalence in children, some of the treatment approaches and recommendations are based on treatment experience in adult patients. However, thanks to scientific and technological development, survival rates have risen considerably. OBJECTIVE This paper presents a review of the principal features of the tumors involving the genitourinary tract in children and an update in genetic background, diagnosis, and treatment. METHODS A narrative review was performed on published literature about genitourinary tract tumors in pediatric patients. Papers presented in English and Spanish literature were reviewed. PubMed, Science Direct, and SciELO databases were used to collect information and present this article. RESULTS Kidney tumors are the most common type of genitourinary tumors in children. Among those, Wilms tumor represents the majority of cases and shows the successful work of clinical trial groups studying this tumor type. Other tumors involving the genitourinary tract in children include Rhabdomyosarcoma, Transitional cell carcinoma, Testicular, and Adrenal tumors. CONCLUSION Genitourinary tract tumors in children represent significant morbidity and economic burden, so awareness in early diagnosis represents improvement in treatment, clinical, and oncological outcomes.
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Affiliation(s)
| | - Nicolás Fernandez
- Division of Urology, Seattle Children´s Hospital, The University of Washington, Seattle, WA, USA
| | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia.,Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
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4
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Ong HL, Lee HJ, Ng TK, Yap TL. Urothelial carcinoma in a child with gross hematuria: a complaint not to be dismissed. BMJ Case Rep 2021; 14:e247239. [PMID: 34853052 PMCID: PMC8638155 DOI: 10.1136/bcr-2021-247239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 11/04/2022] Open
Abstract
Hematuria is not uncommonly seen among children. We describe the case of a 13-year-old boy who was diagnosed with urothelial carcinoma after presenting with persistent gross hematuria for 2 weeks. We highlight the importance of adequate workup for gross hematuria as it is often associated with an underlying pathology that could lead to significant morbidity if left undiagnosed.
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Affiliation(s)
- Han Lim Ong
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Han Jie Lee
- Department of Urology, Singapore General Hospital, Singapore
| | - Tze Kiat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Te-Lu Yap
- Department of Pediatric Surgery, KK Women's and Children's Hospital, Singapore
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5
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Zribi A, Nasr SB, Msakni I, Karrit S, Gargouri F, Fendri S, Balti M, Haddaoui A. Urothelial bladder carcinoma in childhood: a case report. Pan Afr Med J 2020; 36:91. [PMID: 32774650 PMCID: PMC7392873 DOI: 10.11604/pamj.2020.36.91.20416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 05/10/2020] [Indexed: 12/02/2022] Open
Abstract
We report an exceptional case of transitional cell carcinoma of the bladder in a 14-years old boy without personal nor family history who consulted for a total hematuria. Work-up showed a bladder lesion sized 5cm with histology of urothelial cancer. Treatment consisted of a transurethral surgery with carcinologic complete resection. Patient is alive, free of disease with a follow-up of 36 months.
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Affiliation(s)
- Aref Zribi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Sonia Ben Nasr
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Issam Msakni
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of pathology, Montfleury 1008, Tunisia
| | - Sarra Karrit
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Faten Gargouri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of pathology, Montfleury 1008, Tunisia
| | - Sana Fendri
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Mehdi Balti
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
| | - Abderrazek Haddaoui
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisie.,The military hospital of Tunis, Department of medical oncology, Montfleury 1008, Tunisia
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Kantar M, Hekimgil M, Harman M, Oral A, Öge Ö, Avanoglu A. Unusual presentation of diffuse large B-cell non-Hodgkin's lymphoma in children: bilateral ureteral involvement. Pediatr Hematol Oncol 2019; 36:504-509. [PMID: 31566047 DOI: 10.1080/08880018.2019.1663325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin's lymphomas (NHL) are common malignant tumors in children and adolescents. Among them diffuse large B-cell lymphomas (DLBCL) are relatively rare as compared to non-cleaved small cell lymphoma (mostly Burkitt's-BL) and lymphoblastic lymphoma (LL). While BL has abdominal or cervical site predilection, LL (mostly T-cell) tends to have mediastinal involvement. However, diffuse large B-cell lymphomas may involve abdomen, peripheral lymph nodes, skin, bone, other rare sites. Ureteral NHLs are extremely rare in children; however, many cases have been reported in adults. In adults the histopathology is usually follicular lymphoma. Only one case of unilateral ureter DLBCL has been reported in an adolescent in the past. Here we report a case of bilateral ureteral DLBCL to highlight the unusual presentation of NHLs and that it should be considered in the differential diagnosis of acute renal insufficiency.
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Affiliation(s)
- Mehmet Kantar
- Department of Pediatrics, Division of Pediatric Oncology, Ege University School of Medicine, Izmir, Turkey
| | - Mine Hekimgil
- Department of Pathology, Ege University School of Medicine, Izmir, Turkey
| | - Mustafa Harman
- Department of Radiodiagnostics, Ege University School of Medicine, Izmir, Turkey
| | - Aylin Oral
- Department of Nuclear Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Ömer Öge
- Urology Unit, Kent Hospital, Izmir, Turkey
| | - Ali Avanoglu
- Department of Pediatric Surgery, Ege University School of Medicine, Izmir, Turkey
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7
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Rezaee ME, Dunaway CM, Baker ML, Penna FJ, Chavez DR. Urothelial cell carcinoma of the bladder in pediatric patients: a systematic review and data analysis of the world literature. J Pediatr Urol 2019; 15:309-314. [PMID: 31326327 DOI: 10.1016/j.jpurol.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Urothelial cell carcinoma (UCC) of the bladder is exceedingly rare in pediatric patients. Limited data are available to guide management in this population. METHODS The authors systematically searched MEDLINE, Cochrane Library, and Google Scholar (through February 2019) for case reports and series to summarize data regarding presentation, evaluation, management, and follow-up for patients ≤ 18 years diagnosed with UCC of the bladder. Patient-level data were abstracted, and adjusted logistic regression was used to identify factors associated with a combined outcome of recurrence or death. RESULTS One hundred two articles describing 243 patients from 26 countries met criteria. Average age was 12.5 years, 32.6% were female, 15.3% had medical comorbidities, and 13.2% had known risk factors for bladder cancer. Initial management was transurethral resection in 95.5% of patients, whereas 6.2% required secondary intervention. Tumor stage was TaN0M0 in 86.4% and low grade in 93.4%. Recurrence and death occurred in 8.6% and 3.7%, respectively. Mean time to recurrence or death was 8.6 months (standard deviation [SD] 7.6) for 10.7%. Mean disease free follow-up without recurrence or death was 56.9 months (SD 54.2) for 89.3%. Patients with comorbidities, risk factors, or family history (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.02-5.6); ≥TaN0M0 disease (OR: 6.2, 95% CI: 2.5-15.6); and larger tumors at diagnosis (OR: 1.7, 95% CI: 1.2-2.4) had significantly greater adjusted odds of recurrence or death after initial treatment. CONCLUSION Based on pooled results, disease recurrence or death occurred in 10.7% of pediatric patients and within 9 months for most and within 32 months for all patients. This may suggest that low-grade and stage UCC of the bladder in pediatric patients can be systematically monitored for at least 3 years. However, prospective evaluation of this clinical strategy is warranted.
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Affiliation(s)
- M E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - C M Dunaway
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - M L Baker
- Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - F J Penna
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA; Pediatric Urology, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - D R Chavez
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA; Pediatric Urology, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
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8
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Oda MH, Dos Santos DV, Farias AK, de Oliveira L, Falcão BP, Ahn NJ, Amarante AC, Losso GM, Dias AIBDS, Agulham MA, Fachin CG. Bladder Urothelial Carcinoma in a Child: Case Report and Review of Literature. Front Pediatr 2019; 7:385. [PMID: 31620413 PMCID: PMC6763565 DOI: 10.3389/fped.2019.00385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/05/2019] [Indexed: 01/22/2023] Open
Abstract
Bladder urothelial carcinoma (UC) it is the fifth most prevalent carcinoma in humans, nevertheless in children and young adults it's very rare. It usually occurs in older adults. Literature on UC in pediatric population is limited and important information (risk factors, follow-up protocols, etc.) are poorly defined. We present an 11-year-old boy with a painful macroscopic hematuria. Ultrasound revealed a heterogeneous intravesical mass without extravesical extension, which was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The first biopsy was compatible with urothelial papilloma. After 1 year, he returned with a bigger mass. Transurethral resection of the bladder (TURB) was performed and immunohistochemistry showed low-grade papillary UC with a high-grade component, with tumor free margin. Tumor had mutations in the BRAF and KRAS genes. Two and a half years after the resection the patient has no recurrence. Less than 1% of bladder UC occur in the first two decades of life. Gross hematuria is a common symptom. Ultrasound is generally the first diagnostic tool. MRI is also helpful, but cystoscopy allows definitive diagnosis. Transurethral resection of the bladder (TURB) is the standard treatment, with good results and low recurrence rate, and it was the treatment of choice for our patient, that remains free of disease. The BRAF and KRAS gene mutations were never described before in pediatric UC. There are only few cases in literature of pediatric UC that present a tumor genetic profile; therefore, our case report adds more information to this very rare disease in children.
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Affiliation(s)
| | | | - Adria Karina Farias
- Pediatric Surgery Department, University Hospital, Federal University of Parana, Curitiba, Brazil
| | - Leilane de Oliveira
- Pediatric Surgery Department, University Hospital, Federal University of Parana, Curitiba, Brazil
| | - Bruno Pinheiro Falcão
- Pediatric Surgery Department, University Hospital, Federal University of Parana, Curitiba, Brazil
| | - Nicholas J Ahn
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Antônio Carlos Amarante
- Pediatric Surgery Department, University Hospital, Federal University of Parana, Curitiba, Brazil
| | | | | | - Miguel Angelo Agulham
- Pediatric Surgery Department, University Hospital, Federal University of Parana, Curitiba, Brazil
| | - Camila Girardi Fachin
- Pediatric Surgery Department, University Hospital, Federal University of Parana, Curitiba, Brazil
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Uçar M, Demirkaya M, Aytaç Vuruşkan B, Balkan E, Kılıç N. Urothelial Carcinoma of the Bladder in Pediatric Patient: Four Case Series and Review of the Literature. Balkan Med J 2017; 35:268-271. [PMID: 29148427 PMCID: PMC5981125 DOI: 10.4274/balkanmedj.2017.1292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Urothelial carcinoma of the bladder is a rare condition in children, and most cases in this age group are noninvasive and low-grade. However, no follow-up protocol has been defined for this patient group. The objective of this study was to draw attention to bladder tumors in children and focus on the current recommendations for postoperative follow-up along with a case study of four patients. Case Report: Four patients aged <18 years with urothelial carcinoma who were treated in our clinics between 2001 and 2015 were retrospectively evaluated. The results were compared with those of published pediatric case series in the literature. No abnormalities were found in the patients’ physical examinations and laboratory analyses, except hematuria (microscopic or macroscopic). Ultrasonography was used in all the patients to detect lesions in the bladder. Surgical resections were performed endoscopically, except in one patient. Histopathological evaluations revealed low-grade superficial urothelial carcinoma. No recurrence or complication was observed for all patients. Conclusion: Although rarely encountered during childhood, urothelial carcinoma should be considered as a differential diagnosis in pediatric patients with hematuria.
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Affiliation(s)
- Murat Uçar
- Division of Pediatric Urology, Department of Pediatric Surgery, Uludağ University School of Medicine, Bursa, Turkey
| | - Metin Demirkaya
- Division of Pediatric Oncology, Department of Pediatrics, Uludağ University School of Medicine, Bursa, Turkey
| | | | - Emin Balkan
- Division of Pediatric Urology, Department of Pediatric Surgery, Uludağ University School of Medicine, Bursa, Turkey
| | - Nizamettin Kılıç
- Division of Pediatric Urology, Department of Pediatric Surgery, Uludağ University School of Medicine, Bursa, Turkey
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Ribeiro A, Pereira M, Reis A, Ferreira G. Urothelial papilloma: a rare cause of gross haematuria in childhood. BMJ Case Rep 2017; 2017:bcr-2017-219341. [PMID: 28501826 DOI: 10.1136/bcr-2017-219341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bladder urothelial papilloma is extremely rare in the paediatric population. It usually presents as painless gross haematuria and its diagnosis implies a high index of suspicion as other causes of haematuria predominate in this age range. We describe a 9-year-old boy with two episodes of gross haematuria occurring 1 year apart with spontaneous resolution after 2 days. Bladder ultrasound revealed an endovesical papillary lesion of 24×24 mm suggestive of bladder tumour. The diagnosis was confirmed by histopathological examination of the specimen obtained by cystoscopy with transurethral resection. After 3 years of follow-up with ultrasound and cystoscopy, there are no signs of recurrence. Due to the low prevalence of urothelial papilloma, paediatric guidelines for appropriate management and follow-up are unavailable, making this a challenging entity.
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Affiliation(s)
- Andreia Ribeiro
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Maria Pereira
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Armando Reis
- Department of Paediatric Urology, Oporto Hospital Center, Oporto, Portugal
| | - Graça Ferreira
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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11
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Lam MK, Bayne AP, Thomas GA, Austin JC. Invasive High-grade Upper Tract Urothelial Carcinoma in a 14-Year-Old Girl. Urology 2016; 101:145-146. [PMID: 27816604 DOI: 10.1016/j.urology.2016.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 12/01/2022]
Abstract
We present an unusual pediatric case of invasive upper tract urothelial carcinoma with an associated genetic predisposition. A 14-year-old female presented with intermittent right flank pain, and was found to have a poorly functioning hydronephrotic right kidney. Laparoscopic nephrectomy was performed. Pathology demonstrated upper tract urothelial carcinoma, and she subsequently underwent completion ureterectomy. Genetic studies demonstrated a double-hit constitutional deletion of a DNA mismatch repair protein, revealing a rare Lynch syndrome variant known as Constitutional Mismatch Repair Deficiency Syndrome. This disease places her at high risk for multiple malignancies, including upper tract urothelial carcinoma.
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Affiliation(s)
- Michael K Lam
- Department of Urology, Oregon Health & Science University, Portland, OR.
| | - Aaron P Bayne
- Department of Urology, Oregon Health & Science University, Portland, OR
| | - Gregory A Thomas
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Oregon Health & Science University, Portland, OR
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