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Thirty Year Review of Pediatric Bladder Tumors: Beyond Rhabdomyosarcoma
Jason Au, MD, Dung Pham, MD, Stephen Li, BS, John Hicks, MD, Lars Cisek, MD, David Roth, MD.
Baylor College of Medicine, Houston, TX, USA.

Introduction : Primary bladder malignancies are rare in the pediatric population. The majority of bladder malignancies are reported to be Rhabdomyosarcoma (RMS) and the others are rare entities, which are cited in case series or case reports. We present our series on primary bladder malignancies and benign bladder tumors.
Materials and Methods: A 30-year retrospective review (1982-2012) was performed in all children under age 20. We extracted data for children with primary malignant and benign bladder tumors. The malignant group was subdivided into RMS and non-RMS groups. We further categorized the non-RMS group into different subtypes. We analyzed 38 subjects.
Results: The majority of bladder tumors were RMS (Figure 1). All of the benign bladder tumors were nephrogenic adenomas, which were commonly associated with inflammatory conditions: urinary tract infections and bladder stones. Several patients with nephrogenic adenomas had recurrent tumors requiring multiple resections. The two patients with transitional cell carcinoma had low grade/grade 1 tumors. Patients with RMS presented at an average age of 3.57 compared to an average age of 12.57 for patient with other malignant bladder tumors (p=<0.001) (Figures 2, 3). Males with RMS presented at 3.1 years compared to females who presented at 7.9 years (p=0.029). Patients with RMS were more likely to be male when compared to patients with other types of bladder tumors (Figure 4).
Conclusion: While the majority of pediatric bladder tumors are RMS, other rare malignant and benign entities should be considered when evaluating a child with a bladder mass. Especially in adolescents, RMS becomes exceedingly rare and other malignant subtypes become much more common. The pediatric urologist should be aware of these entities and counsel families appropriately.
Figure 2
Nephrogenic adenomaRhabdomyosarcoma (RMS)Other malignant
Number of cases10217
Average age7.00 (2-16; SD 5.18)3.57 (0.17-13; SD 3.50)12.57 (3-18; SD 5.68)
Sex (M/F)5/5 (50/50%)18/3 (86/14%)3/4 (43/57%)

Figure 3
Comparison avg age of presentationp-value
Benign vs. RMS0.062
Benign vs. Other0.078
Benign vs. Malignant (RMS and Others)0.600
RMS vs. Other Malignant<0.001



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