The Clinical Study On Transitional Cell Carcinoma Of The Bladder In Children And Adolescents

Background & Objective: The most common bladder tumor in children and adolescents is rhabdomyosarcoma and transitional cell carcinoma of the bladder is extremely rare. The clinical features of transitional cell carcinoma of the bladder during the first two decades of life are discussed to improve the diagnosis and management level of such disease.Materials and Methods: Three cases identified in our hospital during the years 1988～2006 were presented and 45 cases reported domestically in the past 40 years were analyzed for their clinical manifestation, pathologic character, diagnosis, treatment and prognosis.Results: Among the 48 cases the male-to-female ratio was 2.43:1, patient age ranged from 11 months and 20 years, with a mean age of 12.1--70.83% were between the age of 11and 20. The presenting symptoms were gross hematuria in 83.33% (40 cases), irritative voiding symptoms or recurrent urinary tract infection in 12.5% (6 cases). Other presentations included recurrent hematospermia, the clinical features of acute appendicitis, anemia and incidental detection during routine healthy examination. Original diagnosis and treatment incorrectly occurred in 8 patients (16.67%).In our series ultrasound was 95% sensitive for the detection of intravesical tumors in 20 patients. While IVP or cystography demonstrated abnormalities in 18 of 23 and one case was misdiagnosed as ureterocele. CT of the bladder confirmed the lesions in 7 of 8 and one case was confirmed by MRI. Cytological examination of 11 cases were positive in 2 cases, while one was suspicious for malignant cells and one was atypical. Cystoscopy was 100% sensitive for showing all the lesions in 39 patients.Most of the tumors were solitary papillary lesions and located on the trigone or lateral walls of the bladders. The histological finding were T2 in 2 cases and the others were Ta/T1,44 cases (91.67%) were G0 to GⅡand 4 cases were GⅢ.Of the 48 patients 12 underwent partial cystectomy, 36 underwent transurethral resection. Available following up ranged from 3 months to 16 years, 4 patients suffered from recurrences at 18 months to 32 months postoperatively. No difference is observed in the recurrence rates between the two treatment ways. But there is a significant difference in the disease recurrence rates between the high and low pathologic grades.Conclusions: While rare, children with gross hematuria as the presenting symptom should undergo a complete evaluation to rule out the presence of transitional cell carcinoma. Bladder ultrasound combined with cystoscopy, cystography and urinary cytology are the most important approaches of diagnosis and following up. Partial cystectomy and transurethral resection should be the choice of treatments and every patient should warrant careful long-term follow-up.