Abstract
Introduction: Bladder cancer below the age of 20 years old is not only rare, with an approximated total of 125 cases being collected worldwide by 2010 but it has also been defined as clinico-pathologically distinct from bladder tumors in older age groups. As benign causes of frank hematuria are more common in this age group than tumors, this often leads to a considerable delay in the diagnosis. With this case we would like to emphasize that bladder tumor should be consider in the diagnosis for evaluation of causes for hematuria in younger age groups.
Case Report: We present a case of 15 year old boy who came to us with on and off hematuria since 4 months with occasional passage of clots. No other significant history. No family history of malignancy. No history of smoking. On examination- he had pallor, dehydration and suprapubic tenderness. He was admitted and received 4 units of PRBC for hemodynamic stabilization.
A microscopy and culture test of his urine confirmed his urine to be sterile and urine cytology was negative for malignant cells. On further workup USG showed 5.2x3cm Urinary Bladder growth in right postero-inferior wall suggesting urinary bladder tumor. CECT revealed small polypoidal irregular soft tissue mass in posterolateral wall of urinary bladder and no evidence of any upper tract abnormality, lymph nodes or metastases. He underwent TURBT under spinal anesthesia and perioperative periods were uneventful. HPE reported as low grade papillary urothelial cancer. He was discharged with follow up advice.
Conclusion: Despite its low incidence in children, TCCB must be suspected in the event of macroscopic haematuria. Ultrasound followed by cystoscopy are the ideal diagnostic tools for visualization of these tumours. Follow up must be clinical with periodic ultrasound evaluation. Periodic cystoscopy is indicated only in cases of clinical or ultrasonographic suspicion of recurrence.
Discussion: Neither physical examination nor laboratory analysis revealed any significant abnormalities, but ultrasound showed polypoidal intravesical lesions. Surgical resection was performed endoscopically.
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Corresponding Author
Dr Sumit Gupta
Mch Urology Student
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.153
