Inverted papilloma of the urinary bladder in children: case report and review of prognostic significance and biological potential behavior

Inverted urothelial papilloma: A rare pathology in young girl. A case report and literature review

Bladder cancer is relatively common in the general population but is considered a rare entity in children. Rhabdomyosarcoma is the most frequently encountered bladder tumor in children. Inverted papilloma of the urinary bladder is a rare presentation in adults and is considered extremely rare in the pediatric age group. We report a case of inverted urothelial papilloma (IUP) in the bladder in an 8-year-old girl who presented with painless gross hematuria. Radiological investigations, cystoscopy, and histological examination revealed the rare pathology of IUP of the bladder and a resection was performed. No recurrence was encountered after 3 years of follow-up.

Primary papilloma of the proximal ureter in a 13-year old boy: A rare case

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Primary papilloma of the ureteral proximal end is extremely rare.

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Benign tumors of the ureter are much less frequent than malignant ones.

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The main clinical signs of benign ureteral tumor are hematuria, pain and hydronephrosis.

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The exact diagnosis can be established with histologic study.

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The best noninvasive treatment of benign ureteral mass lesion is a segmental resection of ureter.

Introduction

Approximately 1 percent of the tumors observed in the upper urinary tract are primary tumors of the ureter. The exact diagnosis is done by a histologic study. Most cases need surgery, which is done by complete resection of the tumoral segment of the ureter.

Presentation of case

This study presents a 13-year-old boy who referred to Ali Asghar pediatric hospital with complaints of right flank pain and hematuria for four months. The ultrasonography revealed moderate-grade hydronephrosis. The retrograde urography confirmed a 1.5 cm lesion with filling defects in the proximal segment of the right ureter. The abdominal CT-scan confirmed a 1.5 cm filling defect lesion with a smooth margin in the right proximal ureter adjacent to the ureteropelvic orifice. On cystoscopy, a sessile mass developed in the proximal portion of right ureter and providing pronounced dilation of the ureter and ipsilateral hydronephrosis. Histopathology examination revealed a benign neoplasm composed of a delicate fibrovascular core covered by normal-appearing urothelium. The patient underwent a successful proximal segment resection of the ureter by surgery.

Discussion

Benign tumors of the ureter are much less frequent than malignant ones. Mostly, they involve the lower third of the ureter. Pain, hematuria, and hydronephrosis are the most clinical signs. The final diagnosis can be established with the histologic examination. The choice treatment in is segmental ureterectomy.

Conclusion

Primary ureteral papilloma is extremely rare in the child. The histopathology study is essential for ruling out malignancy. The recurrence and progression of ureteral papilloma are controversial.

A clinical and molecular review of inverted papilloma of the urinary tract: how to handle?

Inverted papilloma (IP) of the urinary tract is classified by the World Health Organisation as a non-invasive urothelial tumour with normal to minimal cytological atypia of the neoplastic cells. During the 1980s, it came under suspicion of having a premalignant or malignant potential and of being concurrent with urothelial cell carcinoma (UCC). This quandary has been proven difficult to solve, due to the fact that IP is very rare and literature mostly consists of case reports with varying levels of information, making strong meta-analyses problematic. New immunohistochemical techniques and genetic approaches are more frequently being used in the attempt to achieve better classifications, prognosis and treatment of lesions hereunder IP. This review will, in our awareness, be the first to combine the knowledge from retrospective studies with these new approaches for determining a possible premalignant potential and concurrency with UCC and subsequently outline a recommendation for follow-up.

Upper urinary tract inverted papillomas: Report of 10 cases

The aim of the study was to review the clinical features and treatments of 10 (9 males and 1 female; age range, 61-73 years; median age, 67 years) upper urinary tract inverted papilloma (IP) cases between 1995 and 2010. The clinical syndromes, diagnostic procedures, treatments and results of the follow-up were evaluated. The results showed that the site of tumor development was the ureter in 6 cases and the renal pelvis in 4 cases. It was also identified that 7 tumors developed on the left side and 3 developed on the right side of the ureter and renal pelvis, respectively. A nephroureterectomy was performed in the first 6 cases, while a partial ureterectomy was performed in 3 cases and a local resection was performed endoscopically in 1 case. All but 2 tumors were solitary, ranging from 5 to 30 mm in diameter. Occurrence in association with transitional cell carcinoma was identified in one case. All 10 patients were subject to follow-up (range, 19-120 months; median, 59 months), during which no recurrence was found. Local excision is considered as adequate treatment when upper urinary tract IP is diagnosed according to strictly defined criteria.

Synchronous inverted papilloma of bladder and renal pelvis

Inverted papilloma of the urinary tract is a rare tumor that consists of uniform urothelial cells with an inverted configuration and a normal urothelial lining. Despite several published reports, the prognostic significance and the potential biologic behavior remain uncertain. We detail a case of synchronous inverted papilloma of the urinary bladder and the renal pelvis and review the published data.

IS SURVEILLANCE NECESSARY FOR INVERTED PAPILLOMA IN THE URINARY BLADDER AND URETHRA?

BACKGROUND

A case series of inverted papilloma of the urinary bladder and urethra is presented, together with a review of the literature with respect to multiplicity, recurrence rate and association with transitional cell carcinoma, and a discussion on surveillance of the lesion.

METHODS

Cases of inverted papilloma of the lower urinary tract in a single centre were reviewed. Patient and tumour characteristics, recurrence and associated transitional cell carcinoma are reported.

RESULTS

Twenty patients were included (18 male, two female). The mean age was 60.8 years (range 35-78 years). All had solitary tumours ranging from 3 mm to 30 mm in size. Median cystoscopic follow up was 30 months (range 2-140 months). There was no recurrence. One patient was associated with subsequent transitional cell carcinoma 44 and 76 months later. Together with the present 20 cases, review of the English literature with respect to inverted papilloma of the lower urinary tract identified a total of 322 cases reported, with a recurrence rate of 3.85%. Moreover, 1.55%, 5.90% and 1.54% were associated with previous, simultaneous and subsequent transitional cell carcinoma, respectively.

CONCLUSIONS

Recurrence is not uncommon and risk of subsequent transitional cell carcinoma is not rare, such that non-invasive surveillance with flexible cystoscopy is recommended for inverted papilloma of the lower urinary tract.

[Inverted papillomas--cases at our service and review of the literature]

Inverted papillomas are rare tumours representing about 2.2% of all urothelial tumours (benign or malignant). Inverted papillomas are predominantly seen in the bladder but these tumours have also been described in other locations, all over the urinary tract. The authors report six additional cases of such tumours describing the individual characteristics of each case, presenting symptoms, treatment employed and follow up available. A review of the literature relative to aetiology, clinical signs and symptoms, diagnostic criteria, treatment options and outcome has also been carried out.