Bladder Urothelial Carcinoma in a Child: Case Report and Review of Literature

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.

Immunotherapy With Bacillus Calmette-Guerin (BCG) in a 16-Year-Old With Urothelial Bladder Carcinoma

“…The main symptom of pediatric patients with UBC is painless macroscopic hematuria. There is a wide range of other unusual presenting symptoms that were reported in literature like urinary frequency, recurrent cystitis, abdominal pain, recurrent urinary tract infections, and vomiting [7]. We performed ultrasonography study as the first diagnostic step to determine the origin of the hematuria.…”

A Case of Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) in Childhood

“…Paner et al declared lower Cyclin D2 hypermethylation and p53 overexpression among less than 20 years old compared to the adult population [ 4 ]. Oda et al proposed that mutations in KRAS, and BRAF genes are possible predisposing factors [ 2 ]. However, previous studies suggested a latency time for a substance to exert its carcinogenic effects; our patient's exposure to second-handed smoke and industrial dyes might cause a synergistic effect.…”

“…Isolated gross hematuria is the most common symptom present in about 75-80% of patients [ 1 , 2 ]. Painless hematuria is more common, followed by irritative symptoms.…”

“…TURB is the best option for the treatment with a low recurrence rate among pediatric patients. A partial bladder cystectomy is an option for those with high-grade tumors or when the cystoscope cannot access the tumor margins to achieve complete resection [ 1 , 2 ]. Intravesical chemotherapy is advised for multifocal and/or high-grade tumors [ 1 ].…”

“…The disease incidence is about 0.1-0.4% for patients younger than twenty years old [ 1 ]. It is the most common bladder tumor between 13 and 18 years [ 1 , 2 ]. Based on a recent systematic review, only 243 patients were reported in the literature until February 2019.…”