Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses

Abstract

Urinary bladder masses are rare in children, and the associated histologic features and prognoses in this population are different from those in adults. Most children with urinary bladder masses present with lower urinary tract symptoms, which may include hematuria, dysuria, frequent urination, and urgency to urinate. However, some of these masses may be identified incidentally or involve generic symptoms such as abdominal distention. In general, pediatric bladder tumors can be divided into those that originate from the bladder epithelium, known as urothelial neoplasms, and mesenchymal bladder neoplasms, which are more prevalent. The most common bladder malignancy in children is a rhabdomyosarcoma, whereas the most common benign bladder lesion in the pediatric population is a papillary urothelial neoplasm of low malignant potential (PUNLMP). The first-line imaging tool for assessing bladder lesions is ultrasonography, which may be followed by a cross-sectional imaging examination such as computed tomography or magnetic resonance imaging if the origin of the mass is unclear or if distant spread is suspected. Although imaging may enable the radiologist to suggest a differential diagnosis based on lesion location and patient age, tissue biopsy generally is required to identify the exact pathologic entity. This is usually performed at cystoscopy and may be curative in cases in which the lesion is small and has low recurrence potential. Knowledge of the clinical, histopathologic, and imaging features of common bladder neoplasms is essential, as it can aid in preventing imaging pitfalls. These may include the misinterpretation of either a pelvic mass as arising from the bladder or a bladder mass as arising from the pelvis, and interpreting an inflammatory mass or bladder detritus as a neoplasm. RSNA, 2017.

Myoepithelial Carcinoma of Urinary Bladder in a Pediatric Patient. A Case Report

“…Cystourethroscopy is very important in undifferentiated lesions, where it is necessary to define the location, extent, and characteristics of the lesion. 9 The pathological variant found in this patient's biopsy is a very rare variant and has not been previously reported in the bladder. The closest reported location to the urogenital apparatus for a myoepithelial tumor was in the scrotum in an older adult patient.…”

Urothelial Papilloma of the Urinary Bladder in Children: Report of Two Cases

“…1 Startlingly, very few publications can be found in English literature, in reference to UNB in the pediatric population. [2][3][4][5][6][7] Fine et al analyzed surgical and histological data regarding three pediatric urology units' cases, all under the age of 20 years, and afflicted with various forms of UNB. Twenty-three cases were reviewed, and urothelial papilloma were prevalent in only two cases.…”

“…However, the endoscopy has the highest level of sensitivity and specificity, an additional MRI or CT scan may prove benefit toward clarifying the malignant potential of the detected lesion. 5 In 2007, we made IVP routinely to visualize if there is any likelihood of an obstruction or intraluminal lesion in the bladder; however, today, this diagnostic tool is rarely used. In cases due to the low incidence of papillomas, there is, as of yet, no standardized guidance regarding the follow-up.…”

Somatic Mutations Profile of a Young Patient With Metastatic Urothelial Carcinoma Reveals Mutations in Genes Involved in Ion Channels

“…The median age for the diagnosis of urothelial carcinoma is approximately 69 years in males and 71 years in females (3). It rarely occurs in young adults (< 20 years of age) with a total incidence of < 200 cases worldwide by 2017 (4). UC in these rare cases are pathologically unique and have molecular features with very few genetic and epigenetic events reported (5).…”