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Abstract：
OBJECTIVE: Bladder cancer is the sixth most common cancer in the United States, but is exceedingly rare in young patients, leading to a lack of accepted standards for diagnosis, treatment, and surveillance. We review our institutional experience with bladder urothelial neoplasms in pediatric and young adult patients summarizing presentation, treatment, and outcomes.
METHODS: Surgical pathology records at our institution were searched for cases of urothelial neoplasms among patients ≤25 years of age treated between January 1997 and September 2016. Cases submitted exclusively for pathology review were excluded. Diagnoses were confirmed based on pathologic examination using the 2004 World Health Organization classification system.
RESULTS: Thirty-four patients were identified with a mean age of 21.1 years (range 8-25 years), and median follow-up was 25.1 months (1-187 months). The male to female ratio was 1.83:1. The most common presenting symptom was hematuria (n=26; 76%). Diagnoses were invasive urothelial carcinoma (n=3), noninvasive urothelial carcinoma (n=24), PUNLMP (n=6), and urothelial papilloma (n=1). Noninvasive lesions were resected by cystoscopy, after which 12% (n=4) experienced complications (grade II or greater). One patient with stage IV invasive disease at diagnosis died, and 2 patients developed recurrences. Of those with noninvasive carcinoma, 29% (n=7) required repeat cystoscopy soon after initial TURBT at outside institutions, and 17% (n=4) had tumors downgraded from high-grade to low-grade after pathology review.
CONCLUSIONS: Hematuria is the most common sign of bladder neoplasia in children and young adults and should be investigated by cystoscopy. The majority of urothelial neoplasms in these patients are noninvasive and can be successfully treated with transurethral resection.
METHODS: Level IV (Retrospective study with no comparison group).
METHODS: Surgical pathology records at our institution were searched for cases of urothelial neoplasms among patients ≤25 years of age treated between January 1997 and September 2016. Cases submitted exclusively for pathology review were excluded. Diagnoses were confirmed based on pathologic examination using the 2004 World Health Organization classification system.
RESULTS: Thirty-four patients were identified with a mean age of 21.1 years (range 8-25 years), and median follow-up was 25.1 months (1-187 months). The male to female ratio was 1.83:1. The most common presenting symptom was hematuria (n=26; 76%). Diagnoses were invasive urothelial carcinoma (n=3), noninvasive urothelial carcinoma (n=24), PUNLMP (n=6), and urothelial papilloma (n=1). Noninvasive lesions were resected by cystoscopy, after which 12% (n=4) experienced complications (grade II or greater). One patient with stage IV invasive disease at diagnosis died, and 2 patients developed recurrences. Of those with noninvasive carcinoma, 29% (n=7) required repeat cystoscopy soon after initial TURBT at outside institutions, and 17% (n=4) had tumors downgraded from high-grade to low-grade after pathology review.
CONCLUSIONS: Hematuria is the most common sign of bladder neoplasia in children and young adults and should be investigated by cystoscopy. The majority of urothelial neoplasms in these patients are noninvasive and can be successfully treated with transurethral resection.
METHODS: Level IV (Retrospective study with no comparison group).
摘要：
目的：膀胱癌是美国第六大最常见的癌症，但在年轻患者中极为罕见，导致缺乏公认的诊断标准，治疗,和监视。我们回顾了我们在儿科和年轻成年患者中膀胱尿路上皮肿瘤的机构经验，治疗,和结果。
方法：在1997年1月至2016年9月之间接受治疗的年龄≤25岁的患者中，在我们机构的手术病理记录中搜索尿路上皮肿瘤病例。排除仅提交病理检查的病例。根据2004年世界卫生组织分类系统的病理检查确认诊断。
结果：确定了34例患者，平均年龄为21.1岁（范围8-25岁），中位随访时间为25.1个月（1-187个月）。男女比例为1.83:1。最常见的症状是血尿（n=26；76％）。诊断为浸润性尿路上皮癌（n=3），非浸润性尿路上皮癌（n=24），PUNLMP（n=6），尿路上皮乳头状瘤（n=1）。膀胱镜检查切除非侵入性病变，之后12％（n=4）出现并发症（II级或更高）。一名诊断为IV期侵袭性疾病的患者死亡，2例患者复发。在那些患有非浸润性癌的人中，29％（n=7）在初次TURBT后不久在外部机构需要重复膀胱镜检查，17％（n=4）的肿瘤在病理检查后从高级别降至低级别。
结论：血尿是儿童和年轻人膀胱肿瘤最常见的体征，应通过膀胱镜检查进行检查。这些患者中的大多数尿路上皮肿瘤是非侵入性的，可以通过经尿道切除术成功治疗。
方法：IV级（无对照组的回顾性研究）。
方法：在1997年1月至2016年9月之间接受治疗的年龄≤25岁的患者中，在我们机构的手术病理记录中搜索尿路上皮肿瘤病例。排除仅提交病理检查的病例。根据2004年世界卫生组织分类系统的病理检查确认诊断。
结果：确定了34例患者，平均年龄为21.1岁（范围8-25岁），中位随访时间为25.1个月（1-187个月）。男女比例为1.83:1。最常见的症状是血尿（n=26；76％）。诊断为浸润性尿路上皮癌（n=3），非浸润性尿路上皮癌（n=24），PUNLMP（n=6），尿路上皮乳头状瘤（n=1）。膀胱镜检查切除非侵入性病变，之后12％（n=4）出现并发症（II级或更高）。一名诊断为IV期侵袭性疾病的患者死亡，2例患者复发。在那些患有非浸润性癌的人中，29％（n=7）在初次TURBT后不久在外部机构需要重复膀胱镜检查，17％（n=4）的肿瘤在病理检查后从高级别降至低级别。
结论：血尿是儿童和年轻人膀胱肿瘤最常见的体征，应通过膀胱镜检查进行检查。这些患者中的大多数尿路上皮肿瘤是非侵入性的，可以通过经尿道切除术成功治疗。
方法：IV级（无对照组的回顾性研究）。
