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Bladder Carcinoma in a Teen-Aged Girl
THE JOURNAL OF UROLOGY
Vol. 78, No. 6, December 1957 Printed in U.S.A.
BLADDER CARCINOMA IN A TEEN-AGED GIRL J. I. WALLER
Al-iD
W. A. ROLL
From the Department of Urology, The Hertzler Clinic and The Hertzler Research Foundation, Halstead, Kansas
Primary papillary carcinoma of the bladder in children is a very rare disease. In 1924 Deming reviewed the literature on primary bladder tumors in children and reported only one case in the first decade of life. This case was described by Charon and Ledeganck. The Carcinoma Registry of the American Urological Association contained two cases in 1949. The Armed Forces Institute of Pathology reported one case in 6,000 below the age of 12 in an 11-year-old child.* Lowry, Soanes and Forbes reported papillary carcinoma grade 1, in a 6-year-old boy in 1955. They stated that theirs was the fifth such case in the literature. Rathbun in 1937 found a total of only 75 cases of all types of bladder tumor in children up to that time. In 1950 Waller and Hamer studied 373 cases of bladder tumor and found none in children. The youngest was 20 years of age and only three were below 27 years of age. The rareness of this type of tumor in the very young patient prompts us to report our case. CASE REPORT
B. G., a 15-year-old girl, was admitted to the Halstead Hospital on August 5, 1954 with the complaint of repeated attacks of gross hematuria. She first saw blood in the urine on June 10, 1954. This lasted for only two voidings and then ceased. One month later she again had gross hematuria associated with some burning and frequency. The urine again became clear after 24 hours and remained clear until August 4, 1954 at which time we first examined her and advised cystoscopy. The patient's appetite had been poor and she was constipated. She had lost 10 pounds of weight during the preceding three months. The patient had had pertussis, measles, mumps and chickenpox. Her tonsils had been removed at the age of 12. In October 1954 the appendix was removed. Other past history and family history were not unusual. The red blood count was 3,330,000 and the white and differential counts ·were normal. Urinalysis: grossly bloody, specific gravity 1.021, albumin 4 plus, sugar negative; microscopic--loaded with red blood cells, no casts. Culture of the urine was reported as no growth. The patient was well developed and well nourished. Her temperature was 98.6F. Pulse was 72 per minute. Physical examination revealed a normal 15year-old girl with no positive findings. On August 6, 1954 cystoscopic examination was made. After blood clots had Accepted for publication May 27, 1957. * Personal communication from Dr. Elbert DeCoursey to Drs. Lowry, Soanes and Forbes (J. Ural., 73: 307, 1955).
764
BLADDER CARCI'\"OIVIA IN TEEN-AGED GIRL
FIG. l
been removed a small papillary tumor was found on the floor of the bladder near the left ureteral orifice. A second tumor was seen just inside the bladder neck on the righL Bilateral pyeloureterograms were normal. On August 9, l under anesthesia, the two tumors were removed by transurethral resection and the base of each fulgurated. Pathological report (Dr. C. A.. Hellwig): The specimen submitted consish: of two of soft tissue. One is translucent . .l\llicroscopic: The bladder tumors are composed of very narrow fibrous strands which contain dilated blood vessels. The cells are arranged in broad sheets. The cells have a clear and a dark stained nucleus. No mitotic figures are seen and the size of the nuclei is quite uniform. In the smaller piece the surface is papillary, the cells are also quite regular in form.; they cover the fibrous septa in many layers. Diagnosis: Papillary earcinorna of the bladder, grade l (fig. 1). SUMMAHY
Papillary carcinoma, 1, in a liJ-year-old girl with two separate tumors in the "'"""''v" lS ,·m~rn,,+,,ri Treatment consisted of t.ransurethral resection of the two tumors and fulguration of the base. The patient has had no recurrence of the tumor for nearly three years and appears quite well. Papillary carcinoma of the bladder in a teen-ager is a very rare disease.
827 Chestnut St.,
Kans.
766
J. I. WALLER AND W. A. ROLL
REFERENCES CHARON AND LEDEGANCK: Bull. Acad. roy. de med. de Belgique, p. 20, 1879. DEMING, C. L.: Primary bladder tumors in the first decade of life. Surg., Gynec. & Obst., 39: 432, 1924. LOWRY, E. C., SoANEs, W. A. AND FoRBES, K. A.: Carcinoma of the bladder in children: Case report. J. Urol., 73: 307, 1955. RATHBUN, N. P.: Primary bladder tumorn in infants and young children. Surg., G,vnec. & Obst., 64: 914, 1937. WALLER, J. I. AND HAMER, H. G.: Bladder tumors: A survey of 373 cases. J. Urol., 64: 651, 1950.
Vol. 78, No. 6, December 1957 Printed in U.S.A.
BLADDER CARCINOMA IN A TEEN-AGED GIRL J. I. WALLER
Al-iD
W. A. ROLL
From the Department of Urology, The Hertzler Clinic and The Hertzler Research Foundation, Halstead, Kansas
Primary papillary carcinoma of the bladder in children is a very rare disease. In 1924 Deming reviewed the literature on primary bladder tumors in children and reported only one case in the first decade of life. This case was described by Charon and Ledeganck. The Carcinoma Registry of the American Urological Association contained two cases in 1949. The Armed Forces Institute of Pathology reported one case in 6,000 below the age of 12 in an 11-year-old child.* Lowry, Soanes and Forbes reported papillary carcinoma grade 1, in a 6-year-old boy in 1955. They stated that theirs was the fifth such case in the literature. Rathbun in 1937 found a total of only 75 cases of all types of bladder tumor in children up to that time. In 1950 Waller and Hamer studied 373 cases of bladder tumor and found none in children. The youngest was 20 years of age and only three were below 27 years of age. The rareness of this type of tumor in the very young patient prompts us to report our case. CASE REPORT
B. G., a 15-year-old girl, was admitted to the Halstead Hospital on August 5, 1954 with the complaint of repeated attacks of gross hematuria. She first saw blood in the urine on June 10, 1954. This lasted for only two voidings and then ceased. One month later she again had gross hematuria associated with some burning and frequency. The urine again became clear after 24 hours and remained clear until August 4, 1954 at which time we first examined her and advised cystoscopy. The patient's appetite had been poor and she was constipated. She had lost 10 pounds of weight during the preceding three months. The patient had had pertussis, measles, mumps and chickenpox. Her tonsils had been removed at the age of 12. In October 1954 the appendix was removed. Other past history and family history were not unusual. The red blood count was 3,330,000 and the white and differential counts ·were normal. Urinalysis: grossly bloody, specific gravity 1.021, albumin 4 plus, sugar negative; microscopic--loaded with red blood cells, no casts. Culture of the urine was reported as no growth. The patient was well developed and well nourished. Her temperature was 98.6F. Pulse was 72 per minute. Physical examination revealed a normal 15year-old girl with no positive findings. On August 6, 1954 cystoscopic examination was made. After blood clots had Accepted for publication May 27, 1957. * Personal communication from Dr. Elbert DeCoursey to Drs. Lowry, Soanes and Forbes (J. Ural., 73: 307, 1955).
764
BLADDER CARCI'\"OIVIA IN TEEN-AGED GIRL
FIG. l
been removed a small papillary tumor was found on the floor of the bladder near the left ureteral orifice. A second tumor was seen just inside the bladder neck on the righL Bilateral pyeloureterograms were normal. On August 9, l under anesthesia, the two tumors were removed by transurethral resection and the base of each fulgurated. Pathological report (Dr. C. A.. Hellwig): The specimen submitted consish: of two of soft tissue. One is translucent . .l\llicroscopic: The bladder tumors are composed of very narrow fibrous strands which contain dilated blood vessels. The cells are arranged in broad sheets. The cells have a clear and a dark stained nucleus. No mitotic figures are seen and the size of the nuclei is quite uniform. In the smaller piece the surface is papillary, the cells are also quite regular in form.; they cover the fibrous septa in many layers. Diagnosis: Papillary earcinorna of the bladder, grade l (fig. 1). SUMMAHY
Papillary carcinoma, 1, in a liJ-year-old girl with two separate tumors in the "'"""''v" lS ,·m~rn,,+,,ri Treatment consisted of t.ransurethral resection of the two tumors and fulguration of the base. The patient has had no recurrence of the tumor for nearly three years and appears quite well. Papillary carcinoma of the bladder in a teen-ager is a very rare disease.
827 Chestnut St.,
Kans.
766
J. I. WALLER AND W. A. ROLL
REFERENCES CHARON AND LEDEGANCK: Bull. Acad. roy. de med. de Belgique, p. 20, 1879. DEMING, C. L.: Primary bladder tumors in the first decade of life. Surg., Gynec. & Obst., 39: 432, 1924. LOWRY, E. C., SoANEs, W. A. AND FoRBES, K. A.: Carcinoma of the bladder in children: Case report. J. Urol., 73: 307, 1955. RATHBUN, N. P.: Primary bladder tumorn in infants and young children. Surg., G,vnec. & Obst., 64: 914, 1937. WALLER, J. I. AND HAMER, H. G.: Bladder tumors: A survey of 373 cases. J. Urol., 64: 651, 1950.