Shelmerdine Susan C, Lorenzo Armando J, Gupta Abha A, Chavhan Govind B
From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.).
Radiographics. 2017 Oct;37(6):1872-1891. doi: 10.1148/rg.2017170031.
Urinary bladder masses are rare in children, and the associated histologic features and prognoses in this population are different from those in adults. Most children with urinary bladder masses present with lower urinary tract symptoms, which may include hematuria, dysuria, frequent urination, and urgency to urinate. However, some of these masses may be identified incidentally or involve generic symptoms such as abdominal distention. In general, pediatric bladder tumors can be divided into those that originate from the bladder epithelium, known as urothelial neoplasms, and mesenchymal bladder neoplasms, which are more prevalent. The most common bladder malignancy in children is a rhabdomyosarcoma, whereas the most common benign bladder lesion in the pediatric population is a papillary urothelial neoplasm of low malignant potential (PUNLMP). The first-line imaging tool for assessing bladder lesions is ultrasonography, which may be followed by a cross-sectional imaging examination such as computed tomography or magnetic resonance imaging if the origin of the mass is unclear or if distant spread is suspected. Although imaging may enable the radiologist to suggest a differential diagnosis based on lesion location and patient age, tissue biopsy generally is required to identify the exact pathologic entity. This is usually performed at cystoscopy and may be curative in cases in which the lesion is small and has low recurrence potential. Knowledge of the clinical, histopathologic, and imaging features of common bladder neoplasms is essential, as it can aid in preventing imaging pitfalls. These may include the misinterpretation of either a pelvic mass as arising from the bladder or a bladder mass as arising from the pelvis, and interpreting an inflammatory mass or bladder detritus as a neoplasm. RSNA, 2017.
膀胱肿块在儿童中较为罕见，该人群中相关的组织学特征和预后与成人不同。大多数患有膀胱肿块的儿童表现为下尿路症状，可能包括血尿、排尿困难、尿频和尿急。然而，其中一些肿块可能是偶然发现的，或者伴有诸如腹胀等一般症状。一般来说，小儿膀胱肿瘤可分为起源于膀胱上皮的肿瘤，即尿路上皮肿瘤，以及更常见的间质性膀胱肿瘤。儿童最常见的膀胱恶性肿瘤是横纹肌肉瘤，而小儿人群中最常见的膀胱良性病变是低恶性潜能乳头状尿路上皮肿瘤（PUNLMP）。评估膀胱病变的一线影像学工具是超声检查，如果肿块的起源不明或怀疑有远处转移，可能随后进行横断面成像检查，如计算机断层扫描或磁共振成像。尽管影像学检查可能使放射科医生能够根据病变位置和患者年龄提出鉴别诊断，但通常需要组织活检来确定确切的病理实体。这通常在膀胱镜检查时进行，对于病变较小且复发潜能低的病例可能具有治愈性。了解常见膀胱肿瘤的临床、组织病理学和影像学特征至关重要，因为这有助于避免影像学陷阱。这些陷阱可能包括将盆腔肿块误诊为起源于膀胱，或将膀胱肿块误诊为起源于盆腔，以及将炎性肿块或膀胱碎屑误诊为肿瘤。RSNA，2017年。
