Bladder tumors in children

Case report: Ectopic corpus cavernosum presented as bladder tumor in a 3-year-old boy

Background

Ectopic tissue is rarely found in the bladder for adults. Currently, there have been reports of ectopic prostate and colon tissue in the bladder. These ectopic tissues are manifested as a bladder mass and cause lower urinary tract symptoms. However, the ectopic corpus cavernosum in the bladder has never been reported, and its clinical characteristics and treatment have not been explored yet.

Case summary

A 3-year-old boy was admitted to the hospital due to 1 month of urinary frequency. The physical examination was unremarkable. Urine analysis from other hospitals showed an elevated urine white blood cell count of 17.9/ul. In addition, ultrasound indicated a possible bladder mass. CT and MRI showed a well-margined lesion (1.9×1.9 cm) in the bladder trigone. Through preoperative imaging, we diagnosed a bladder tumor (inclined towards benign). The transurethral resection of the bladder tumor was performed. Unfortunately, the surgery was unsuccessful due to the difficulty in removing the excised tissue through the urethra. Subsequently, bladder incision and tumor resection were performed. The tumor was successfully removed. Surprisingly, the postoperative pathology showed that the tumor tissue was corpus cavernosum. The pathological diagnosis was ectopic corpus cavernosum in the bladder. No complications were found after the operation, and no recurrence was observed during follow-up.

Conclusion

The ectopic corpus cavernosum in the bladder has never been reported for children, which is presented as a benign tumor with rapid proliferation and large size. Surgery is recommended. However, the transurethral resection of bladder tumors is difficult to perform due to narrow urethra and limited surgical instruments. Bladder incision and tumor resection may be preferred.

Urothelial cell carcinoma of the bladder in pediatric patients: a systematic review and data analysis of the world literature

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.

Multiple hemangiomas of the urinary bladder in a child with gross hematuria

We report a case of multiple hemangiomas involving the urinary bladder in a 4-year-old boy who presented with recurrent episodes of gross hematuria. On ultrasonography, compared with the bladder wall, the lesions presented as multiple isoechoic polypoid intraluminal masses with mildly increased vascularity on color Doppler exam. Cavernous hemangioma was confirmed by cold-cup biopsy, and the all lesions were coagulated with a Holmium laser. Despite their rarity, bladder hemangiomas should be included in the differential diagnosis of multiple intravesical masses in children with gross hematuria.

Klippel-Trénaunay syndrome: 2 case reports and a review of genitourinary manifestations

PURPOSE

We summarize the literature and present our experience with genitourinary manifestations of the Klippel-Trénaunay syndrome, which can lead to challenging management problems.

MATERIALS AND METHODS

We report on 2 patients with genitourinary manifestations of the Klippel-Trénaunay syndrome and performed a MEDLINE review of the literature using the key words "Klippel-Trénaunay," "vascular malformation" and "genitourinary."

RESULTS

Genitourinary manifestations were cited in 18 articles, including 1,174 cases of the Klippel-Trénaunay syndrome, detailing the presentation and management of bladder, external genitalia and retroperitoneal involvement in the Klippel-Trénaunay syndrome. The overall genitourinary symptoms in patients with the Klippel-Trénaunay syndrome seem to occur in the more severe cases and usually involve cutaneous vascular malformations of the trunk, pelvis and genitalia.

CONCLUSIONS

Intra-abdominal and intrapelvic extension of the vascular malformations of the Klippel-Trénaunay syndrome frequently occurs concurrently with the lower abdominal, pelvic cutaneous involvement of the external genitalia, as in our 2 cases and in our review of the literature. These data provide a better understanding of the spectrum of genitourinary manifestations in the Klippel-Trénaunay syndrome and provide insight for the clinician to formulate individual therapies for these patients.

Genitourinary neurofibromatosis mimicking posterior urethral valves

A 12-year-old boy, examined after an episode of acute urinary retention, was found to have neurofibromatosis of the bladder neck and prostatic urethra. His symptoms of bladder outlet obstruction and radiographic findings of a dilated prostatic urethra mimicked posterior urethral valves. Complete urologic investigation, including cystourethroscopy, revealed that the dilatation of the prostatic urethra was secondary to neural involvement of the external sphincter and posterior urethra without mechanical obstruction or posterior urethral valves.

Neurofibromatosis with involvement of the prostate gland

Urologic manifestations of neurofibromatosis type 1 are rare. The most common urologic area of involvement has been the urinary bladder. Prostate involvement in generalized neurofibromatosis has been noted previously in only 10 patients, 3 of whom were adults. Of these 3, 1 had a neurofibroma, 1 had a malignant schwannoma, and 1 patient died before tissue diagnosis could be obtained. The patient discussed in this report is the second known adult patient with biopsy-proven neurofibroma of the prostate gland. In addition, this is the first reported use of endorectal magnetic resonance imaging of the prostate to localize and specify the extent of neurofibromas in these patients.

MRI of pelvic neurofibromatosis

Pelvic neurofibromatosis is a rare disease and rarely involves the prostate. A 19-year-old male presented with irritative and obstructive voiding symptoms. Magnetic resonance imaging showed a large mass extending from the sacral promontory to the perirectal and perivesical spaces and to the proximal root of the penis. The mass also involved the prostate. The characteristics of the mass were highly suggestive for neurofibroma. Prostate biopsy showed neurofibroma, and the immunohistochemistry stain for S-100 protein was positive.

Neurofibromatosis: bladder involvement with malignant degeneration

A solitary neurofibroma of the urinary tract is rare. More rare in the urinary tract are neurofibromas associated with the neurofibromatosis of Von Recklinghausen's disease. A case of multiple neurofibromas of the bladder degenerating into neurofibrosarcoma is described.

Transitional cell carcinoma of bladder in children

Transitional cell carcinoma of the bladder occurs rarely during the first two decades of life. The malignancy is usually low grade and noninvasive, with a low recurrence rate. Transurethral resection or fulguration is the treatment of choice, and the prognosis is favorable. We present 4 patients, aged two to eighteen years, with transitional cell carcinoma of the bladder and review the literature.

Congenital genitourinary hemangiomas in a patient with the Klippel-Trenaunay syndrome: management with the neodymium:YAG laser

The Klippel-Trenaunay syndrome is an unusual congenital anomaly characterized by cutaneous hemangiomas, multiple varicosities, soft tissue hypertrophy and, rarely, gastrointestinal or genitourinary hemangiomas. The large bladder as well as multiple penile hemangiomas in our patient were treated successfully with the neodymium:YAG laser with minimal morbidity.

Hamartoma of the bladder in a 4-year-old girl with hamartomatous polyps of the gastrointestinal tract

We report on a girl with hamartomatous intestinal polyps and a large mass that involved most of the posterior wall of the bladder, which on microscopic examination had the characteristics of a hamartoma. Hamartomas are among the rarest of bladder tumors. Our case is only the third reported under this designation, although 3 other cases may fall into this category. Of the 6 patients 4 have been children. Although most polypoid bladder tumors in children are rhabdomyosarcomas of the botryoid type, our case illustrates that rarely other lesions are similar grossly. Recognition of these lesions has clinical implications with regard to therapy and prognosis.

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 papilloma of the bladder

Bladder tumors of epithelial origin are rare in children. A 7-year-old male presented with intermittent painless hematuria. An ultrasound examination of the bladder revealed a single polypoid mass which proved to be a transitional cell papilloma.

Genitourinary neurofibromatosis in childhood

Neurofibromatosis in children occurs uncommonly and involvement of the bladder is exceedingly rare. The syndrome is transmitted as an autosomal dominant trait and is characterized by cutaneous pigmentation and tumors of neural crest origin. Hypertension has been documented in association with neurofibromatosis in the form of renovascular disease in children and with pheochromocytomas in adults. We report on 2 children with extensive neurofibromas of the bladder, upper tract damage and genital enlargement. One case was misdiagnosed as posterior urethral valves and the other case as clitoral hypertrophy. The literature of urogenital neurofibromatosis is reviewed with particular attention to bladder lesions, hypertension, malignant potential and treatment options.

Rhabdomyosarcoma of the kidney in children

Among 227 consecutive renal tumors examined from the Hospital de Niños de Buenos Aires, seven examples of a distinctive clinicopathological entity occurred. These renal neoplasms were all unilateral, grossly infiltrative without a definitive capsule. Microscopically, the lesion was characterized by a sarcomatous pattern with a rhabdomyoblastic differentiation. Four of them had regional lymph node involvement at surgery. Four developed bone metastases and none had lung metastases. In three instances, the bone metastases were histologically similar to the original neoplasm. The age of the patients ranged from 11 months to 5 1/2 years. A male predominance was observed. Two patients died; one is alive 5 years after surgery; three are alive with metastases; one has been followed for less than a year. In this study, it is proposed that another group of tumors be removed from the Wilms' tumor classification. The neoplasm has been described previously in the literature under several names. It is not clearly related clinicopathologically to nephroblastoma. The term rhabdomyosarcoma is proposed in view of its entirely different biological behavior.

Leiomyosarcoma of urinary bladder

Leiomyosarcoma of the bladder remains a rare diagnosis with poor therapeutic results. The available data continue to support surgical intervention as the mainstay of therapy, although other modalities have been employed with varying success. A case report and review of the literature with current treatment alternatives are presented.

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.

Leiomyosarcoma of urinary bladder in children

A case of leiomyosarcoma of the bladder is reported in a fourteen-year-old girl who is alive and without evidence of disease two years after partial cystectomy. Electron microscopy confirmed its smooth muscle nature. The data for 7 other children, including follow-up for 5, are tabulated. Partial cystectomy with adequate margin appears to be the treatment of choice when feasible. The tumor may be controlled with chemotherapy and radiation therapy in unresectable cases.

Neurofibromatosis of the bladder in children: case report and literature review

A case of plexiform neurofibroma of the lower urinary tract is presented as well as a review of all previously reported cases in childhood. We suggest aggressive management in patients with diffuse disease.

Hemangioma of bladder

A twenty-nine-year-old woman had a history of recurring gross, total painless hematuria. The past history and urologic studies supported the diagnosis of hemangioma of the bladder. A partial cystectomy was performed. The pertinent literature is reviewed.

Adenocarcinoma of the bladder in a boy

The first case of adenocarcinoma of the bladder in a boy is described. Clinically, there were red friable granular areas over an exstrophic bladder. Multiple bladder biopsies revealed adenocarcinoma, which was treated with total cystoprostatectomy, ureterosigmoidostomy and reconstruction of the epispadias with a good result. In view of the early malignant change in an exstrophic bladder it is advantageous to perform multiple bladder biopsies, especially in older children before undertaking surgical treatment. These biopsies would help to detect the early malignant change and determine the plan of treatment.

Neurofibromatosis involving the lower urinary tract in children. A report of three cases and a review of the literature

Three children with neurofibromatosis involving the lower urinary tract are reported and their clinical, radiological and pathological findings are described. Lower urinary tract involvement in neurofibromatosis has previously been reported in 17 children, 12 of whom had other stigmata of von Recklinghausens disease. Lower urinary tract involvement may be asymptomatic and can be found incidentally. Every case with neurofibromatosis presenting with what may appear to be even only insignificant urinary symptoms should be thoroughly investigated urologically. Symptoms are usually related to urinary tract obstruction or neurogenic bladder dysfunction due to the involvement of the nerves supplying the bladder. Urinary diversion is the treatment of choice as surgical removal of the extensive tumour is seldom feasible. Following treatment the prognosis for survival appears to be good.

Von Recklinghausen's disease presenting as scrotal tumor

A five-year-old boy had an asymptomatic, periurethral, scrotal-perineal mass. An unusual associated urethral defect was subsequently discovered. The locally aggressive lesion was excised and urethroplasty accomplished. The histopathologic diagnosis proved to be plexiform neurofibroma. This is a forme fruste example of ectodermal dysplasia known as neurofibromatosis. I believe this is the first report of similar scrotal, perineal, or periurethral involvement in the syndrome.

Carcinoma of the bladder in children

Apparently, epithelial bladder tumors in children differ markedly from their more malignant counterparts in adults. The childhood bladder epithelial tumors morphologically are of a lower grade malignancy, show no evidence of invasion and no tendency to recur. Therefore, all cases thus far reported have resulted in a benign clinical course with a 100 per cent survival rate. These childhood epithelial bladder tumors apparently do not recur, which is in sharp contrast to their adult counterparts. However, this should not lessen the urologist's obligation to provide routine cystoscopic re-evaluation.