Urinary bladder cavernous hemangioma in a 3-year-old: A rare case report

Abstract

Cavernous hemangioma (CH) of urinary bladder occurs relatively infrequently, accounting for 0.6% of all bladder tumors. This tumor may occur sporadically or coexist with other benign and malignant vascular lesions. In this report, we present a rare case of CH in a 3-year-old Ugandan girl. A 3-year-old girl was referred to Mbarara Regional Referral Hospital (MRRH) for urological evaluation following a 3-year history of intravaginal swelling, dysuria, and heavy hematuria resulting in anemia. Imaging was consistent with polypoid bladder mass arising from the bladder trigone. Embryonal rhabdomyosarcoma was suspected based on clinical eyeballing. She was worked up for chemotherapy and received 26 cycles of vincristine sulfate, actinomycin-d, and cyclophosphamide (VAC). Biopsy and fulguration were performed after optimizing the patient. Histopathology confirmed CH. The surgery was uneventful and resulted in complete cure. CH should be considered in the differential diagnosis of childhood genitourinary masses. It is a rare entity in the real-life clinical practice and therefore can be overlooked. Excision biopsy and histology should be performed before initiating the patients to chemotherapy. CH is very insensitive to chemotherapy and therefore surgery maybe adequate in resource-limited settings.

Keywords: cavernous hemangioma; embryonal rhabdomyosarcoma.

FIGURE 1

(A) Polypoid mass (PM), Vagina (V), and urethra (U) viewed during physical examination. (B) Followed examination under anesthesia (EUA), excision and fulguration was performed

FIGURE 2

Transverse and longitudinal abdominal ultrasound images show lobulated heterogeneous solid mass in the urinary bladder lumen (A) and moderately dilated left renal calyces (B)

FIGURE 3

(A and B) Axial and sagittal CECT images show a large lobulated polypoid intravesical heterogeneously enhancing mass, which appears to arise from the trigone of the urinary bladder (blue arrows)

FIGURE 4

Axial (A) and coronal (B) CECT images show left hydroureteronephrosis (white arrows)

FIGURE 5

Numerous dilated vascular channels laden with red blood cells indicated in black arrows in A and B

FIGURE 6

Follow up abdominopelic ultasound scan.Normal urinary bladder(6A), and resolution of hydroureteronephrosis(6B)