Transitional cell carcinoma of bladder in pediatric patients
Purpose Only 30 cases of transitional cell carcinoma are reported in children younger then 10 years of age. In “young” patients it is generally a low grade-stage tumour with low recurrence and progression. We report our experience from 1999 to 2006. Material and methods Seven patients (3 males, 4 females, aged 6 to16 years old) presented with gross painless hematuria not trauma related. As an initial screening procedure, bladder-renal ultrasonography showed a bladder lesion. Cystoscopy was performed under general anesthesia. Results A single papillary lesion was observed near the ureteral orefice in all cases. Size ranged from 1.5 to 2 cm. All patients underwent transurethral resection, and superficial biopsies were taken . Pathological grading, using the WHO/ISUP 2004 Classification, revealed 4 urothelial papillomas and 3 papillary urothelial neoplasms of low malignant potential (PUNLMPs). All were superficial to the lamina propria. At follow-up urinalysis and urine cytology were checked monthly, bladder ultrasonography every three months and cystoscopy at six and twelve months for the first year after surgery. Subsequently urinalysis and urine cytology were done every three months, bladder ultrasound every six months and cystoscopy every year. At an average follow-up of 35 months (range 6 to 84 months) no recurrence was detected. Conclusions Transitional cell carcinoma of the bladder is rare in children, and its long term prognosis is still unknown. Routine follow-up with urinary cytology and bladder ultrasound is adeguate. Cystoscopy can be reserved for patients with high grade or potentially highly malignant lesions. Multicenter protocols are required.