Fibroepithelial Polyp at the Bladder Neck Presenting with Gross Hematuria in a 5-Year-Old Boy

Abstract

Background: In any age group, gross hematuria is an alarming symptom. A variety of diseases, including urinary tract tumors, urinary tract infections, glomerulonephritis, urinary stone disease, and urinary trauma, can cause gross hematuria. Neoplasms of the urinary tract are definitely the most bothersome among the differential diagnoses. Fibroepithelial polyps (FEPs), in contrast, are mesodermal-originated rare and benign tumors that can be observed in the urinary tract. In this case report, we present a child with an FEP at the bladder neck that was referred because of gross hematuria. Case Presentation: A 5-year-old boy presented with intermittent gross hematuria for 2 weeks. Ultrasonography showed a 2 × 1 cm mucosal surface-borne polypoid lesion at the trigon. Patient underwent cystoscopic evaluation that revealed a polypoid mass located at the bladder neck; however, there were no signs of bladder outlet obstruction in the bladder. Transurethral resection revealed an FEP. Conclusion: Hematuria should be evaluated carefully not only in adults but also in children. FEPs in bladder can mimic bladder carcinoma clinically and radiologically. It should be kept in mind in the differential diagnosis of bladder lesions on imaging modalities in pediatric population.

Keywords: fibroepithelial polyp; hematuria; pediatric.

FIG. 1.

(A) Axial plane sonogram image at pelvic level, mucosal surface-borne polypoid lesion in the bladder at the trigon level (arrow). (B) Axial plane sonogram image at pelvic level, the polypoid lesion (open arrow) is seen. Bladder wall thickness is normal, perivesical fat planes are clear (solid arrow). There is no sign of invasion. (C) Axial plane sonogram image at pelvic level, in color Doppler US, vascularization is not seen in the polypoid lesion (arrow). (D) The polyp specimen, right after en bloc resection. US, ultrasonography.

FIG. 2.

(A) The polyp covered with urothelial epithelium and has loose fibrovascular stroma transitional epithelium covering the fibrovascular stroma. (HE, 40 × ). (B) Histopathologic examination of the polyp, there is no sign of atypia and/or dysplasia (HE, 40 × ). HE, hematoxylin eosin.