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CASE REPORT
Year : 2009  |  Volume : 1  |  Issue : 1  |  Page : 30-31 Table of Contents     

Pseudotumor of the urinary bladder in a child: A case report and review of the literature


Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221005, U.P, India

Date of Submission17-Dec-2008
Date of Acceptance04-Feb-2009

Correspondence Address:
Punit Srivastava
Department of Pediatric Surgery, IMS, BHU, Varanasi - 221 005, U.P
India
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DOI: 10.4103/0974-7796.48785

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   Abstract 

Inflammatory pseudotumors (IPTs) are rare, nonepithelial tumors of the urinary bladder that are benign. They are very difficult to distinguish from sarcomas or carcinomas of the urinary bladder in children. Conservative surgical management by either transurethral resection or partial cystectomy is the treatment of choice. We report here a rare case of juvenile urinary bladder IPT that we managed by right partial cystectomy with right ureteric reimplantation because of involvement of the right ureteric orifice. On account of histological similarity of IPT to malignant urinary bladder tumors, it is mandatory to require definite diagnosis and long-term close follow up.

Keywords: Bladder, inflammatory, pseudotumor


How to cite this article:
Srivastava P, Gangopadhyay A N, Gupta D K, Upadhyaya V D. Pseudotumor of the urinary bladder in a child: A case report and review of the literature. Urol Ann 2009;1:30-1

How to cite this URL:
Srivastava P, Gangopadhyay A N, Gupta D K, Upadhyaya V D. Pseudotumor of the urinary bladder in a child: A case report and review of the literature. Urol Ann [serial online] 2009 [cited 2019 Aug 23];1:30-1. Available from: http://www.urologyannals.com/text.asp?2009/1/1/30/48785


   Introduction Top


Inflammatory myofibroblastic tumor of the urinary bladder is an uncommon benign condition of unknown neoplastic potential. Of all urinary bladder masses, 1-5% are mesenchymal in origins. [1] In adults the tumor is seen in association with instrumentation of the lower genitourinary tract, while in children the exact etiology is not known. Its clinical and radiological presentation in children resembles sarcoma. The consequence of such misinterpretation is radical tumor resection, despite the presence of a benign inflammatory process. [2] Patients present most commonly with an ulcerating bleeding mass, hematuria, and voiding symptoms. This condition is more common in adults between ages of 15-74 years. [3] Inflammatory pseudotumors (IPTs) rarely occur in children, and only one case has been reported in a neonate to date. [4] The pathogenesis of IPT is not clearly known, some have postulated that the lesion develops in response to infection, inflammation, or malignancy, but the causative relationship has not yet been proven. [5] These lesions are locally aggressive with an invasive growth pattern and fail to progress after resection. The clinical management includes conservative treatment by antibiotics, transurethral resection, and partial cystectomy, depending on the condition.


   Case Report Top


An 8-year-old boy presented to us with history of fever and burning micturation of one month duration. Although he had a history of suprapubic pain there was no history of hematuria. The physical examination revealed a palpable suprapubic mass up to umbilicus. Urine examination showed numerous pus cells and RBC. Abdominal ultrasound showed intravesical bladder mass arising from posterior and lateral bladder wall. CT scan of the abdomen revealed 5 5 4 cm multilobulated endophytic isodence mass lesion arising from posterior and lateral wall of the urinary bladder with normal thickness of bladder wall [Figure 1]. Cystoscopy revealed a hypervascular solid submucosal mass measuring approximately 5-4 cm arising from the posterior and lateral aspect of the bladder. The trigone appeared not to be affected. Three tissue specimens were obtained by transurethral resection. Tissue biopsy from this portion of the mass showed a proliferation of cytological bland spindle cells mixed with chronic inflammatory and plasma cells, confirming the diagnosis of IPT. Urinary catheter was inserted and intravenous antibiotics were initiated, but the treatment failed to regress the tumor even after three weeks. Three weeks into antibiotics the child developed gross hematuria with blood clot and signs of hypovolumia. He was resuscitated with intravenous fluid and blood transfusion. On urinary bladder exploration, the bladder cavity had multiple polypoidal mass-like lesions arising from right posterior and lateral bladder wall [Figure 2], for which partial cystectomy with right ureteric reimplantation was done with suprapubic cystostomy. The suprapubic catheter was removed after three weeks and the child was keeping well with normal urination during the follow-up evaluation.


   Discussion Top


Inflammatory pseudotumors of the urinary bladder has been described by many names, including pseudosarcomatous myofibroblastic proliferation, pseudomalignant spindle cell proliferation, pseudosarcoma, nodular fasciitis of the bladder, and reactive pseudosarcomatous response. Roth first described the lesion as a reactive pseudosarcomatous response in 1980. [6] In the past, these lesions have often been initially misdiagnosed as malignancies such as sarcomatoid urothelial carcinoma, leiomyosarcoma, and rhabdomyosarcoma. IPT presents with nonspecific symptoms, including hematuria, dysuria, urinary frequency and urgency, urinary obstruction, and pelvic pain. [7] On cystoscopic examination, IPT usually appears as a polypoid or nodular, sometimes ulcerated, exophytic mass with broad attachment to the bladder wall. On pathologic examination, IPT must be carefully distinguished from similar malignant lesions of the urinary bladder. Treatment of IPT usually consists of antibiotics, transurethral resection, or partial cystectomy. [8] Recurrence of IPT has recently been reported in three cases, but metastasis has not been reported. [8]

Although we managed this case by intravenous antibiotics for three weeks as per literature, [9] the child failed to respond to the therapy and developed gross hematuria. Finally, partial cystectomy with ureteric reimplantation in bladder was done to avoid hematuria in future. We conclude that benign nature of bladder IPT doesn't take lightly when treated with complete conservative management in a child. The proper diagnosis and close follow-up is mandatory and the patient should be hospitalized to avoid life-threatening situations and managed accordingly.

 
   References Top

1.Poon KS, Moreira O, Jones EC, Treissman S, Gleave ME. Inflammatory pseudotumor of the bladder: A report of five cases and a review of the literature. Can J Urol 2001;8:1409-15.  Back to cited text no. 1  [PUBMED]  
2.Netto JM, Pιrez LM, Kelly DR, Joseph DB. Pediatric inflammatory bladder tumors: Myofibroblastic and eosinophilic subtypes. J Urol 1999;162:1424-9.  Back to cited text no. 2    
3.Iczkowski KA, Shanks JH, Gadaleanu V, Cheng L, Jones EC, Neumann R, et al. Inflammatory pseudotumor and sarcoma of urinary bladder: Differential diagnosis and outcome in thirty-eight spindle cell neoplasm's. Mod Pathol 2001;14:1043-51.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Asanuma H, Nakai H, Shishido S, Tajima E, Kawamura T, Morikawa Y, et al. Inflammatory pseudotumor of the bladder in neonates. Int J Urol 2000;7:421-4.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Narla LD, Newman B, Spottswood SS, Narla S, Kolli R. Inflammatory pseudotumor. RadioGraphics 2003;23:719-29.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Roth JA. Reactive pseudosarcomatous response in urinary bladder. Urology 1980;16:635-7.  Back to cited text no. 6  [PUBMED]  
7.Bulusu AD, Hopkins T. Inflammatory pseudotumor of the bladder. Urology 1998;51:487-8.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Harik LR, Merino C, Coindre JM, Amin MB, Pedeutour F, Weiss SW. Pseudosarcomatous myofibroblastic proliferations of the bladder: A clinicopathologic study of 42 cases. Am J Surg Pathol 2006;30:787-94.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Sandhu SS, Iacovou JW. Pseudotumor of the bladder. J R Soc Med 1997;90:46-7.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]


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  [Figure 1], [Figure 2]



 

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