Urethral caruncle in a 9-year-old girl: a case report and review of the literature

Abstract

IntroductionUrethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in post-menopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present an unusual case of a pediatric patient with a urethral caruncle, along with a review of the literature.Case presentationA 9-year-old Mongolian girl was referred to our hospital with a 2-week history of frequent adherence of a small amount of blood to her underwear. We found a sessile smooth margin, a clear boundary and an elastic, soft red tumor over the entire circumference of the urethral meatus. At the beginning, because of the child’s age, urethral prolapse was suspected. There was no response after 3 weeks of conservative treatment with steroid ointment. With the patient under general anesthesia, a partial tumor resection was performed for the purpose of histological examination. The tumor excision was limited to about 1/2 laps of the urethral meatus to prevent the development of urethral stricture. On the basis of clinical and histopathological examinations, a diagnosis of a urethral caruncle was made. Post-operatively, steroid ointment application to residual masses was continued, and these disappeared about 6 months later. Our patient was free of recurrence and had had no complications after 3 years of follow-up.ConclusionsUrethral caruncles are rare in children, and the possibility of malignancy is slight during this period. Biopsy of the mass is not required for diagnosis. It should be indicated only if the mass has other characteristics that raise suspicion of malignancy. In previously reported cases, all of the tumor was removed. However, the trigger of the caruncle in childhood is chronic inflammation. Conservative therapy with steroid ointment should be the core treatment. However, it may be necessary to proceed to treatment because caruncles take a long time to heal. The case that we describe in this report will serve as an example for similar cases in the future.

Clinical characteristics of urethral prolapse in Japanese children

“…Pediatric UP is a rare condition found primarily in premenarchal black girls. 4 To the best of our knowledge, the cases of only nine Asian girls with UP have been reported in the English-language literature, [6][7][8][9] suggesting that the incidence of UP may be lower in Asia than in other regions. Based on around 80 reported cases in this study and the total number of approximately 58 750 000 live births since 1972 in Japan, the incidence of pediatric UP is estimated as 1 in 73 000 girls.…”

Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl

“…This occurs mainly at the posterior lip [1] of the urethra, and the exact aetiology is still uncertain [3]. But two possibilities suggested as aetiological factors are chronic inflammation and oestrogen deficiency [1, 4]. After analysing few cases reported in children, there was a suggestion of aetiology as congenital [4].…”

“…But two possibilities suggested as aetiological factors are chronic inflammation and oestrogen deficiency [1, 4]. After analysing few cases reported in children, there was a suggestion of aetiology as congenital [4]. …”

“…If it is not visible clearly diagnosis is difficult [4]. When presented as a mass protruding through vagina in young girls, urethral prolapse and malignancy should be excluded [4]. …”

“…Management options found in the literature are either conservative such as diethylstilbestrol [1, 3] ointment and topical steroid ointments [1, 4] or invasive as surgical excision and electrocoagulation [2]. It is clearly stated that surgical excision is the most preferred method among urologist for larger lesions which are not responding to conservative therapy [6].…”