Urothelial Carcinoma of Urinary Bladder in a 12 Year-Old Boy

Bladder cancer is the fifth most prevalent carcinoma in humans. It affects both genders with a male-to-female ratio of 3:1 (Gakis et al., 2013), reaching the highest incidence in the sixth decade of life. Urothelial bladder tumors are very rare in childhood. Since 1950, there are less than 100 cases reported in patients less than 30 years, and even less in children and adolescents. We present a new case and make an overview of the literature.


Introduction
Bladder cancer is the fifth most prevalent carcinoma in humans.It affects both genders with a male-to-female ratio of 3:1 (Gakis et al., 2013), reaching the highest incidence in the sixth decade of life.Urothelial bladder tumors are very rare in childhood.Since 1950, there are less than 100 cases reported in patients less than 30 years, and even less in children and adolescents.We present a new case and make an overview of the literature.

Case Report
A 12 year-old boy presented with pain in the right groin.The patient reported great-grandfather with bladder carcinoma, and personal history of surgery for inguinal hernia.
The clinical and analytical examinations were normal.The urinalysis revealed the presence of microhematuria.The ultrasonography showed a 17x16-mm mass suggesting a bladder tumor in the right hemitrigone that was subsequently confirmed with a CT scan, which was requested by pediatrics doctors before receiving the patient in our service.(Figure 1).The upper urinary tract was normal in CT.The patient underwent transurethral resection of the bladder tumor without complications, and pathologic examination revealed a low-grade urothelial tumor not

Abstract
Urothelial bladder tumors in children are an uncommon pathology, and they are not usually associated with exposure to carcinogenic factors.We report the case of a 12 year-old child diagnosed with a bladder carcinoma after performing ultrasound for microhematuria.The transurethral resection revealed a low grade urothelial carcinoma (pTa).After 5 years of follow-up, the patient is disease free.Urothelial bladder tumors in young people should be suspected in case of painless gross hematuria.They are usually solitary, low grade and nonmuscle-invasive tumors and their standard treatment is the transurethral resection.The recurrence rate is very low, so it has been proposed a follow-up based on ultrasound monitoring.Cystoscopy should be reserved for cases of high suspicion of recurrence.The patient was followed with periodic ultrasounds and there is no evidence of tumor in bladder or in upper urinary tract after 5 years of follow-up.

Discussion
Bladder transitional-cell carcinoma is extremely rare in the first two decades of life.The estimated frequency in patients under 40 is less than 1% in all cases (Khaisidy et al., 1990) A significant association was found between urothelial tumors and a mutation in the p53 gene.In adults, this mutation is observed in highly differentiated and aggressive tumors, whereas in young people it is also present in low-grade tumors.A study by Linn et al. (1991), from 73 tumors in patients younger than 30 years, found 81% of them to be low-grade pTa tumors.Alterations in the p53 gene can be found in the majority of tumors, suggesting that the modification of this gene may not correlate with poor prognosis tumors.The most commonly reported symptoms are in order of frequency: gross hematuria (80%), irritative urinary symptoms or recurrent urinary tract infections (15%) and microscopic hematuria (5%).(Khaisidy et al., 1990).
The diagnosis is usually done with ultrasound and cystoscopy (Hoenig et al. 1996;Dennery et al. 2002).The urine cytology has a low sensitivity in detecting these tumors.(Hoenig et al.1996;Lerena et al. 2010).This is probably because the majority of bladder tumors in these patients are low grade.In our case, the urinary cytology was negative; and although CT scan was performed to __________________________________________________________________________ ______________________________________________________________________________________________________________ ______________ José Francisco Flores-Martín, Fernando Vázquez-Alonso, Ignacio Puche-Sanz and José Manuel Cózar-Olmo (2015), Obstetrics & Gynecology: International Journal of Research in Urology, DOI: 10.5171/2015.889329invading the lamina propria (low grade pTa).Immunohistochemical analysis of p53 was positive in this case.

Figure 1 (
Figure 1 (TC with 17x16-mm mass suggesting a bladder tumor in the right hemitrigone) .