HaeMANGIOMA OF BLADDER IN CHILDREN AND YOUNG ADULTS

Abstract

SUMMARY AND CONCLUSIONS A case is reported of hamangioma of bladder occurring in a boy aged 4 years. The nature and treatment of this lesion as it affects young people is reviewed with an analysis of 31 cases previously reported in the first two decades of life. The following points emerge: Hzmangioma of bladder usually presents with recurrent episodes of hzmaturia which may be associated with anamia. Hamangiomatous lesions elsewhere on the body have been described in 31 per cent. of the cases reported to date. Some abnormality of the bladder outline in the intravenous pjelogram was noted in only 50 per cent. of cases in which this investigation was done. Although there is some disagreement. it is generally considered that biopsy should be avoided for fear of provoking troublesome bleeding. In two‐thirds of the reported cases the lesion has been solitary and well defined, usually involving the upper half of the bladder. It is exceptional for these lesions to involve the ureteric orifices or bladder neck. Hamangiomata may achieve great size, and 64 per cent. involved the muscular layers of the bladder wall, many of which extended into the perivesical tissue. Cavernous haemangioma is the most common histological type. Partial cystectomy appears to be the most safe and effective method of treatment.

Hemangioma of the Bladder with Extravesical Extension

“…Significant findings on intravenous urography are de pendent on size and location [7], It reveals bladder filling defects in 50% of the cases [8]. In the 1970s pelvic angiog raphy was reported to be useful in establishing the preop erative diagnosis.…”

“…In about one quarter to one third of the reported cases, the bladder lesion has been seen in conjunction with cutaneous mani festations of arteriovenous malformation such as caver nous hemangioma or portlike stains over abdomen, peri neum, and thighs [1,3,6,8], They may also be seen in associated syndromes such as Sturge-Weber or KlippelTrenaunay-Weber [6,[9][10][11], It is estimated that 3-6% of the patients with the Klippel-Trenaunay syndrome have bladder hemangiomas [6], Thus, Leonard et al [12] rec ommend complete urological evaluation in cases with such syndromes or cutaneous hemangiomas. Bladder he mangioma occurs without apparent sex predilection, and more than 50% of the patients arc less than 20 years old, although it may be seen in any age group [5,8].…”

“…Lymphatic elements occasionally may be seen [8]. Sixtysix per cent of the bladder hemangiomas are solitary lesions, occurring usually on dome or trigone [1,8]. They tend to be rarely located at bladder neck or ureteral orifice [13].…”

“…They tend to be rarely located at bladder neck or ureteral orifice [13]. The size of the lesion varies from a few millimeters to 10 cm in diameter or even greater [1,7], Submucosal extension occurs in 36% of the cases and muscular exten sion in 64% [8], Occasionally the tumors extend extravesically, and they may invade other pelvic organs. Gross, painless, recurrent hematuria is the most frequent clinical symptom [1], Other symptoms include lower abdominal pain and vesical irritation [1,7,9], The clinical diagnosis is mainly established by cystoscopic examination because most of the lesions are sessile, broad based, and multilobulated with a bluish-red color.…”

“…Usually there is a mixture with the pre dominant component determining the type [1], They are seen as a collection of thick or thin-walled blood vessels beneath an intact layer of transitional cell epithelium. Lymphatic elements occasionally may be seen [8]. Sixtysix per cent of the bladder hemangiomas are solitary lesions, occurring usually on dome or trigone [1,8].…”