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Genito-Urinary Tumors

Tumors of the genito-urinary tract in children

While it is very rare, tumors can occur in organs of the male or female genital or urinary tract in children. These tumors may be benign or malignant (cancerous).

Tumors in genital organs of children include tumors of the:

  • Testicle
  • Paratesticular soft tissue
  • Ovary
  • Vagina
  • Uterus

Tumors in the urinary tract of children include tumors of the:

  • Kidney
  • Bladder
  • Prostate gland

These tumors are rare and if they prove to be cancerous the treatment complex, frequently involving several therapies in a multi-faceted approach; management often involves a team of specialists; in addition to a pediatric urologic surgeon the team may consist of a pediatric diagnostic radiologist, a pediatric general surgeon, a pediatric oncologist and a pediatric radiotherapist.

Testis Tumors 

Testis tumors in children may be benign or malignant. The most common benign tumor is an epidermoid cyst; the most common malignant tumor is a germ cell tumor. Epidermoid cysts are lined by cells which look like skin cells (epidermis). Germ cells are the cells which differentiate into sperm (testicle) or egg (ovary) cells in the post pubertal male/female. Several types of testicular germ cell tumors have been described, the most common being termed a yolk sac tumor due to its resemblance to cells found in the embryonic yolk sac.

Most testicular tumors occur in pre-school age children (The peak age is 2) but may occur at any age. They most commonly present as a hard painless mass in the scrotal sac. They must be distinguished from several other more common conditions which will cause swelling or enlargement of the scrotal sac such as hydroceles, inguinal hernias, testicular torsion, and epididymitis.

If a child develops a hard, painless mass in the scrotal sac a scrotal ultrasound examination may be very useful to clarify impressions of the physical examination—is the enlargement/tumor in or next to the testicle, is it cystic or solid, does it have blood flow to it. These features help determine what the tumor is most likely to be.

Germ cells tumors often secrete a protein which is measurable in the blood. If there is strong suspicion from the examination and diagnostic tests that the tumor may be a malignancy it must be surgically removed or biopsied.

Treatment of testicular malignancies will often include subsequent (following surgery) chemotherapy and occasionally radiation therapy (X-ray treatment). They are very responsive to treatment and cure rates are very high. Benign tumors generally require no further treatment beyond excision.

Paratesticular Tumors 

Tumors may occur in the tissue adjacent to the testicle. They are commonly termed soft tissue tumors and the most common is termed rhabdomyosarcoma due to the resemblance to skeletal muscle cells.

They generally present as a hard painless mass in a pre-school age child (the peak age is between 2 and 3). The physical examination and scrotal ultrasound will reveal a solid mass next to but not part of the testicle.

The suspicion of a possible malignant tumor must then be confirmed by surgery which generally will include removal of the mass and near-by testicle. Further treatment of these tumors will include chemotherapy with or without radiation therapy. They are responsive to therapy and have a high cure rate.

Ovarian Tumors 

Ovarian tumors occur at all childhood ages and may be benign or malignant (cancerous). The most common benign tumors are cysts of the ovarian follicle (any age) or corpus luteum (ovulating adolescents only); the most common malignant tumors are germ cell tumors.

Children with an ovarian tumor usually present with abdominal pain or an abdominal mass. The intra-abdominal location of the ovary means that these tumors will often grow quite large before they are detected.

Ovarian germ cell tumors secrete a protein which is detectable in the blood. Imaging studies which are very useful in a patient who presents with abdominal pain, abdominal swelling or abdominal mass include abdominal ultrasound, CT scan and magnetic resonance imaging (MRI).

Small follicular cysts, causing no symptoms, do not necessarily require treatment. Large or symptomatic ovarian cysts and solid ovarian tumors need to be removed. Ovarian germ cell tumors will also be treated with chemotherapy and possibly radiation therapy and have a very good prognosis.

Vaginal Tumors 

Tumors of the vagina in children appear in the tissue just beneath the epithelial lining of the vagina. They are termed soft tissue tumors and the most common variety is rhabdomyoscarcoma due to its resemblance to skeletal muscle. The peak age for their occurrence is 2 to 3. They usually are large and present as a palpable abdominal/pelvic mass. Occasionally they fill the vaginal cavity and spill out the opening between the labia. When this happens they usually cause vaginal bleeding.

Imaging studies, which help lead to a diagnosis in patients with an abdominal mass include ultrasound, CT scan and MRI. Generally the diagnosis must be confirmed with a biopsy of the tumor.

Treatment for vaginal rhabdomysarcoma includes chemotherapy and radiation therapy. They are very responsive to treatment and have an excellent prognosis.

Uterine Tumors 

Tumors of the uterus in children arise in the tissue just beneath the epithelial lining of the uterus. They are termed soft tissue tumors and the most common variety is rhabdomyoscarcoma due to its resemblance to skeletal muscle. The peak age for their occurrence is 2-3 years but they may also occur in older children. They usually are large and present as a palpable abdominal/pelvic mass.

Imaging studies which help lead to a diagnosis in patients with an abdominal mass include ultrasound, CT scan and MRI. Generally the diagnosis must be confirmed with a biopsy of the tumor.

Treatment for uterine rhabdomysarcoma includes chemotherapy and radiation therapy. They are responsive to treatment and have an very good prognosis.

Kidney Tumors 

Kidney tumors are one of the most common sites of cancer in children, though they are still uncommon. The most common is termed Wilms tumor in recognition of a German pathologist who reported details of this tumor more than 100 years ago. Non-malignant masses in the kidney are usually infectious, inflammatory or cystic in nature. Infectious conditions may be related to reflux and urinary tract infection. There are numerous cystic conditions of the kidney, some involving only one kidney with a single cyst, others involving both kidneys with multiple cysts. They can be inherited or occur sporadically. Treatment and prognosis (renal impairment) varies.

Malignant kidney tumors in children almost always present as an abdominal mass though less commonly there may also be visible bleeding in the urine. They occur throughout childhood but most commonly in young children with a peak age of occurrence of 2 to 3.

Evaluation of any child with an abdominal mass on physical examination should include an abdominal ultrasound. This study will usually clarify where the tumor is located or originating from which then helps determine what it may be. Further valuable information can often be obtained with a CT scan and/or MRI.

Depending on nature, size, location and extent of the tumor, surgery to remove or biopsy the tumor will usually be necessary for diagnosis and treatment or treatment planning. Besides surgical removal, Wilms tumors are treated with chemotherapy and occasionally radiation therapy. They respond extremely well to treatment and have a very high cure rate.

Bladder/Prostate Tumors 

Tumors originating in the bladder or prostate area usually arise in the tissue just beneath the epithelial lining of the bladder or prostatic urethra. They are termed soft tissue tumors and the most common is termed rhabdomyosarcoma due to its resemblance to skeletal muscle.

Bladder and prostate tumors occur most commonly in young children at a peak age of 3 to 4, but can be seen at any age in childhood. They grow rapidly and present as a lower abdominal mass. Because of the location at the outlet of the bladder they may cause difficulties with urination by obstructing flow. A mass in this area detected on physical examination should be evaluated with an abdominal/pelvic ultrasound. Additional valuable information can often be obtained with a CT scan and/or MRI.

Depending on the size, location and extent of the tumor surgery to biopsy or remove the tumor will usually be necessary for diagnosis and treatment ortreatment planning. Chemotherapy and usually radiation therapy are given to children with pelvic rhabdomyosarcoma. They respond well and the prognosis is generally good.