Transitional Cell Carcinoma of the Bladder in Children Long Term Follow-Up

Research Article

Austin J Urol.2016; 3(1): 1039.

Transitional Cell Carcinoma of the Bladder in Children Long Term Follow-Up

Marte A*

Department of Urology and Pediatric Surgery, University of Naples, Italy

*Corresponding author: Antonio Marte, Department of Urology and Pediatric Surgery, University of Naples, Largo Madonna Delle Grazie, Italy

Received: November 12, 2015; Accepted: January 04, 2015; Published: January 05, 2016

Abstract

Summary: The aim of our study is to report on long term follow-up on TCCB in children.

Materials and Methods: From 1990 to 2014, 5 patients, female, age range 12-15 years (mean 13.2 years), were referred to our center with TCCB. In 4 patients the clinical symptoms debut was a 'gross hematuria. Of these, 1 patient had been operated on two years before, for UPJ obstruction with double-J stent apposition. The endoscopy performed during this operation as a diagnostic routine did not show any abnormality of the bladder wall. In 1 patient the tumor was an incidental finding during cystoscopy for endoscopic correction of vesicoureteral reflux. All patients underwent successful transurethral resection by pediatric resectoscope.

Results: At a mean follow-up of 15 years no recurrence was registered. All patients underwent to the following follow-up: endoscopy, renal and bladder ultrasound and urinary cytology every 6 months the first year. US and urinary cytology every 6 months the first two year then yearly and out of protocol after 5 years free of disease. The oldest patients of this series were recently contacted by telephone interview to prepare the present review by asking them to perform a reno-vesical ultrasound which was negative in all patients.

Conclusion: The low incidence of TCC shows the rarity of this finding in the pediatric population and an unexpected exclusive prerogative of the female sex, in our experience. The main clinical manifestation of such injuries is haematuria; commonly these are solitary lesions, low-grade histology and low risk of progression. Our case studies, probably one of the longest follow-up in the literature, confirm that in this age group the prognosis also in the long term is particularly favorable.

Keywords: Bladder; Children; Transitional cell carcinoma

Introduction

Transitional Cell Carcinoma of the Bladder (TCCB) is a rare disease in the first two decades of life. It occurs with a frequency that is 9 times higher in males than females and its origin is commonly type mesothelial. On the basis of the 1973 World Health Organization classification, tumors were classified as Transitional Cell Carcinoma of the Urinary Bladder (TCCB). Owing to more detailed histological criteria, this term has been replaced by papillary urothelial neoplasm of low malignant potential and low-grade carcinoma of the urinary bladder in the World Health Organization-International Society of Urologic Pathology consensus classification system of urothelial neoplasms 2004. Cases of TCCB, and reported in the literature regarding the pediatric population, are less than 150.

In 1969, Javadpour e Mostofi conducted a study of 10,000 patients with TCCB and found that only 40 of these were less than 20 years [1]. Many studies have subsequently described the characteristics of these tumors in children that, in many ways, manifest differently from adult forms as often these are solitary lesions, low-grade and rarely tend to relapse [2,3]. The aim of our study is to report our experience of TCCB in children.

Materials and Methods

From 1990 to 2014, 5 patients, female, age range 12-15 years (mean 13.2 years), were referred to our center with TCCB. All patients had a family and medical history negative for risk factors such as family history of cancer of the urinary tract, chronic exposure to carcinogens such as benzidine, diaminofenile, 4-nitrodiphenyl and use of anticancer drugs such as cyclophosphamide. In 4 patients the clinical symptoms debut was a 'gross hematuria. Of these, 1 patient had been operated on two years before, for UPJ obstruction with double-J stent apposition. The endoscopy performed during this operation as a diagnostic routine did not show any abnormality of the bladder wall. In 1 patient the tumor was an incidental finding during cystoscopy for endoscopic correction of vesicoureteral reflux.

All patients underwent to the following diagnostic tests: urinalysis with cytology and reno vesical ultrasound. In all patients, urinary cytology was not indicative for the TCCB. Reno vesical ultrasound demonstrated the presence of a vegetating formation protruding into the bladder cavity (0.9cm-1.2cm), at posterolateral bladder wall (three left / two right) without any involvement of the ipsilateral ureteral ostium. In one case a previous US made diagnosis of left intravesical ureterocele (17 x 9 mm) associated to duplex left system. Transurethral resection was performed in all patients by pediatric resectoscope removing completely the lesion. (Figure 1-3) No complications occurred in any patient after surgery. In one case, given the particular macroscopic aspect and microscopic extemporaneous examination of the lesion, the patient was administered a single dose of 40mg of mitomycin C in 40cc of saline for intravesical instillation soon after the resection of the tumor. The lesions removed were examined Histologically (Figure 4) (Table 1).