Multiple and recurrent epithelial tumors of the bladder in a child

Transitional cell papilloma of the bladder in a child: a case report and review of literature

Transitional cell papillomas of the bladder are tumours of epithelial origin that are extremely rare in children. A large number have been found to be sited adjacent to one of the ureteric orifices. They are benign and endoscopic excision has been considered curative; however, the rate of recurrence reported in the literature is fairly high, with the earliest recurrence being at 3 months. We report the case of a 7-year-old girl who presented with the rare lesion situated just above the right ureteric orifice.

UROTHELIAL NEOPLASMS IN PATIENTS 20 YEARS OR YOUNGER: A CLINICOPATHOLOGICAL ANALYSIS USING THE WORLD HEALTH ORGANIZATION 2004 BLADDER CONSENSUS CLASSIFICATION

PURPOSE

Urothelial neoplasms in patients younger than 20 years are rare, with conflicting data regarding clinical outcomes.

MATERIALS AND METHODS

We identified 23 patients 4 to 20 years old with urothelial neoplasms, reclassified the microscopic diagnoses using the 2004 WHO/International Society of Urologic Pathology grading classification and collected data on presentation, risk factors and outcomes.

RESULTS

Pathological grading revealed 2 urothelial papillomas, 10 papillary urothelial neoplasms of low malignant potential (PUNLMPs), and 8 low grade and 3 high grade papillary urothelial cancers, all without invasion. Mean patient age was 13.2 years (range 4 to 20), 19 patients were male and 19 presented with gross hematuria. All lesions were solitary and measured 0.1 to 6 cm. One patient had a history of smoking and 1 had parents who smoked. Three patients (13%) had recurrences classified as either urothelial papilloma (1) or PUNLMP (2). All patients were alive with no evidence of disease after a mean followup of 4.5 years (range 6 months to 13 years).

CONCLUSIONS

Urothelial neoplasms in individuals younger than 20 years more commonly occur in males and are predominantly low grade with a favorable clinical outcome. Before the current classification system the 10 patients with a diagnosis of PUNLMP would have been classified as having papillary carcinoma. Thus, the diagnostic category of PUNLMP allowed 43.5% of patients in this series to avoid being labeled with "cancer" at a young age.

Transitional cell carcinoma of the bladder in young adults

A retrospective survey of young servicemen presenting with transitional cell carcinoma of the bladder aged 40 years or below is presented, 19 such patients having been identified over a 20-year period. The results were compared with those of other similar series. The tumour behaviour appears to vary with age at presentation, its propensity for multifocal presentation, recurrence, progression to invasion and mortality all rising over the first 4 decades of life. These trends appear to be linked to grade and stage at presentation, and also tend to rise with age rather than altered tumour behaviour. The follow-up of young adults should thus be the same as for older patients presenting with the same grade and stage tumours.

Transitional cell carcinoma of bladder in children and adolescents

Transitional cell carcinoma of the bladder is rare in patients under sixteen years of age. A case is described in a ten-year-old boy, and the literature is reviewed. The diagnosis and treatment of this tumor is the same in childhood as in older patients. Recurrence as well as death have been reported in this age group; therefore, these patients warrant careful long-term follow-up.

Transitional cell papillary bladder neoplasm in a girl: an unusual presentation

An 8-year-old girl presented with the clinical features of acute appendicitis. The removed appendix was normal but the abdominal pain persisted. There were no urinary symptoms and bacteriological examination of the urine was negative. An ultrasound scan showed an intravesical tumor that was subsequently excised. Histology showed a grade 1 transitional cell papillary bladder carcinoma of low grade malignancy. All previously reported cases have presented with urinary tract symptoms, usually hematuria.

Transitional cell carcinoma of the bladder in children: radiologic appearance and differential diagnosis

Primary epithelial tumors of the bladder are rare in children. We report a case of transitional cell carcinoma (TCCa) of the bladder in a 10-year-old boy who was evaluated with intravenous urography, ultrasonography, and computed tomography (CT). The radiographic appearance and a differential diagnosis are discussed. The literature of TCCa of the bladder in children is reviewed.

Long-term followup of patients less than 30 years old with transitional cell carcinoma of bladder

A review of our records between 1970 and 1986 identified 22 patients with transitional cell carcinoma of the bladder who were less than 31 years old. Of these patients 7 were less than 20 years old (group 1) and 15 were 20 to 30 years old (group 2). The tumors usually were of low grade and low stage. Patients in group 1 had no recurrences, whereas 6 patients (40 per cent) in group 2 had recurrences. Upstaging occurred in 2 patients with tumor recurrence. It would appear that while transitional cell carcinoma of the bladder in patients less than 20 years old has a more favorable prognosis, in patients 20 to 30 years old the prognosis is poorer and similar to that observed in older patients.

Primary epithelial tumors of the bladder in children

Epithelial tumors of the bladder in children are extremely rare and recurrences are even more unusual. We report 3 cases of which 2 had recurrence. ABO(H) antigens were negative in 1 case and they were mildly positive in the other. Although the current opinion is that epithelial tumors in children are benign and single, with a low incidence of malignancy, 3 other pediatric cases of epithelial tumor recurrence have been reported in the literature. Therefore, we wish to emphasize the importance of long-term and careful followup of these patients, since further recurrences are possible.

Transitional cell carcinoma of the bladder in an adolescent with Turner's syndrome

Primary epithelial tumors of the bladder are extremely rare in children and adolescents. We report a case of transitional cell carcinoma in an adolescent with Turner's syndrome. The patient presented with intermittent gross hematuria and mild dysuria. A mass was identified on the trigone of the bladder near the left ureteral orifice, and histological evaluation revealed grade II to III in situ papillary transitional cell carcinoma with foci of submucosal invasion. Transurethral resection of the tumor was performed, and the patient remains free of disease 2 1/2 years later. The literature on transitional cell carcinoma of the bladder in children is reviewed.

Transitional cell papillary carcinoma of the bladder in a child

We report a rare case of transitional cell papillary carcinoma of the bladder in a 10-year-old girl who had hematuria. The tumor was diagnosed and assessed through VCUG and ultrasound. The tumor protruded into the urethra during micturition and its mobility was observed by both diagnostic procedures.

Transitional cell carcinoma of the bladder in children and adolescents

A review of our records between 1950 and 1980 identified 12 patients with transitional cell carcinoma of the bladder who were less than 21 years old. The tumors were low grade and low stage, and were associated with an excellent prognosis. Only 1 patient had a solitary recurrence. This study supports the contention that transitional cell carcinoma of the bladder is a less aggressive disease in patients who are in the first 2 decades of life than in older patients.

Urinary bladder tumours in children. Case report of inverted papilloma

A short review is given of tumours of the urinary bladder in children, and the first case of an inverted papilloma in a child is reported. The tumour was situated in the trigone of the bladder and was successfully extirpated, with no recurrence at follow-up 9 months later. It was histologically typical of these tumours. The 105 patients described in the literature had an average age of 55 years, whereas the present case is the first to be described arising during the first two decades of life. The most frequent symptoms of such tumours are haematuria and urinary obstruction. It is suggested that the treatment of choice is transurethral excision. The term Brunnian adenoma is recommended for use with this tumour, in order to avoid the impression given by the name papilloma of the bladder, that the tumour is malignant.

Recurrent bladder papilloma in a child with Cushing's syndrome. Case report

A case of bladder papilloma in a 12-year-old boy with Cushing's syndrome was reported by us in 1975. A walnut-sized papilloma was removed by transvesical extirpation, and bilateral adrenalectomy was performed. Two years later he was reoperated because of recurrent Cushing syndrome, and at the same time he had a recurrence of multiple bladder papillomas. Since removal of residual adrenocortical tissue and hormone substitution therapy his Cushing appearance has disappeared completely. The recurrent papillomas were removed by transurethral electrocoagulation and control cystoscopies have shown no sign tumour recurrence. We suggest a possible neoplastic effect of some tryptophan metabolites(s) in combination with immunosuppression as the cause of the bladder papillomas.