Neuroblastoma of the Urinary Bladder, Preclinically Detected by Mass Screening

Abstract

ABSTRACT. Background. Since the introduction of mass screening of infants for neuroblastoma, the incidence of neuroblastoma has increased in Japan. The reason for this increased incidence is the possible inclusion of many neuroblastomas that would have regressed spontaneously and would never have been detected clinically. An extremely rare tumor at the dome of the urinary bladder in a 7-month-old infant was detected by the mass screening.Methods. A case of neuroblastoma of the urinary bladder is reported with a review of the literature. The data in the Japan Children's Cancer Registry are also reviewed to analyze the incidence and the site of origin of neuroblastoma for evaluation of mass screening.Results. A 7-month-old female infant was referred because of a positive urine vanillylmanderic acid screening test. Ultrasonography showed a solid mass attached to the urinary bladder. At laparotomy a 35 ؋ 30 ؋ 25-mm egg-shaped tumor was found at the dome of the bladder, and a partial cystectomy was performed. During the operation no changes in blood pressure occurred when the tumor was manipulated. Histologic diagnosis was rosette-fibrillary neuroblastoma originating in the bladder wall, with a favorable Shimada histopathologic classification. N-myc was not amplified, which predicted a favorable prognosis, and no postoperative chemotherapy was given. The patient was free of symptoms and tumor after a follow-up period of 16 months. Literature review revealed that this was the second case of neuroblastoma of the urinary bladder ever reported in the world, although several cases of pheochromocytoma originating in the bladder wall had been reported. Both neuroblastoma and pheochromocytoma derive from the neural crest. The sympathogonia from the neural crest, a common stem cell, differentiates into a ganglion cell or into a secretory cell known as a chromaffin cell, able to manufacture catecholamines. The first case in the world that was reported as neuroblastoma of the urinary bladder was in a 4-month-old infant who was noted to have a 4-cm lower abdominal mass on routine physical examination. A ganglioneuroblastoma of the dome of the bladder was excised and the patient was doing well. On reviewing the Japan Children's Cancer Registry, the incidence of neuroblastomas in infants has increased as well as the number of stage 1, 2, and 4s (stage 4 special) neuroblastomas since the introduction of mass screening. However, there has been no significant change in the number of stage 3 or 4 diseases diagnosed in older children. According to the Japan Children's Cancer Registry, pelvic origin neuroblastoma, which has been noted to have spontaneous regression, was more frequent in the primary tumors detected by mass screening when compared with those presenting clinically. During preparation of this manuscript another case of bladder dome neuroblastoma was detected by urinary vanillylmanderic acid screening of 6-month-old infants for neuroblastoma in Japan.Conclusion. These extremely rare cases of neuroblastoma of the urinary blad...

Pediatric bladder neuroblastoma: Case report and literature review

“…2 Only 6 previous cases of bladder NBL have been reported to date. [3][4][5][6][7] Two other cases presented with gross hematuria. 6,7 Of the remaining cases, 3 were asymptomatic, and detected as a result of a mass screening program, 4,5 and one case was discovered as a palpable mass on physical examination.…”

“…6,7 Of the remaining cases, 3 were asymptomatic, and detected as a result of a mass screening program, 4,5 and one case was discovered as a palpable mass on physical examination. 6 Five out of 6 reported cases of bladder NBL also occurred at the dome of the bladder, [3][4][5]7 with one tumour arising from the anterior bladder wall. 6 In four of the previously described cases, the patients underwent immediate partial cystectomy without neoadjuvant or adjuvant chemotherapy or radiation required.…”

Coeliac disease and ganglioneuroblastoma: An unusual association

“…They are characterized by the onset of chronic secretory diarrhea with hypokalemia, increased VIP values both in the blood and tumor as well as increased urinary catecholamine Key words: coeliac disease; ganglioneuroblastoma; childhood cancer ------Abbreviations: AGA, antigliadin antibody; AEA, antiendomysium antibody; hTG, antibodies to human tissue transglutaminase levels. The most frequent sites of such tumors in children are the adrenal medulla and the retroperitoneal paravertebral ganglia [3]. Bloom et al in 1973 reported increased VIP levels in adults with retroperitoneal ganglioneuroblastoma.…”

Neuroblastoma of the urinary bladder in an infant clinically detected by hematuria

“…Neuroblastoma of the urinary bladder is extremely unusual. We have reviewed the literature and found only three cases of neuroblastoma primarily located in the dome of the urinary bladder that have been reported [3][4][5]. Two of them were asymptomatic and were found only as a con-sequence of mass screening programs in Japan [4,5].…”

“…We have reviewed the literature and found only three cases of neuroblastoma primarily located in the dome of the urinary bladder that have been reported [3][4][5]. Two of them were asymptomatic and were found only as a con-sequence of mass screening programs in Japan [4,5]. Certainly, rhabdomyosarcoma was the most likely clinical diagnosis based on the clinical signs and imaging studies because that soft tissue sarcoma frequently affects the genitourinary structures of the pelvis in both males and females.…”