Delayed diagnosis of pediatric bladder and prostate rhabdomyosarcoma – causes and consequences
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The English Division Pediatric Oncology Scientific Circle, Medical University of Gdansk, Gdansk, Poland
Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
Małgorzata Styczewska   

The English Division Pediatric Oncology Scientific Circle, Medical University of Gdansk, Debinki 7, 80-211 Gdańsk, Poland.
Submission date: 2020-06-08
Final revision date: 2020-09-10
Acceptance date: 2020-09-10
Online publication date: 2021-04-13
Pediatric rhabdomyosarcoma (RMS) is a rare disease, affecting 4.5-6.0 per 1 000 000 children a year. Bladder and/or prostate (B&P) is the primary tumor site in approximately 10% of patients. Initial symptoms of B&P RMS in children may mimic more common, benign conditions such as urinary tract infections (UTIs), functional disorders, and congenital anomalies of the urinary tract.

The study aims to emphasize the role of careful clinical examination and strict following the diagnostic guidelines in early detection of pediatric B&P RMS in primary care and emergency department settings.

Case study:
We present two male patients aged 2.5 and 3 years with embryonal B&P RMS initially manifesting as atypical and/or recurrent UTI. In both children, proper diagnoses were delayed due to careless physical examination and failure to adhere to the current guidelines for UTI management. Despite symptoms of an atypical and severe course of UTI, no imaging examinations had been performed for several weeks until dramatic deteriorations of patients’ general conditions occurred.

Results and discussion:
The prolonged diagnostic processes caused unnecessary suffering of both children and significant delay of oncological treatment in one. In the latter patient, bladder preservation was not possible, resulting in decreased quality of life.

Due to its rarity, B&P RMS is infrequently included in the differential diagnosis in children with recurrent or atypical UTI. However, thorough physical examination and adherence to the guidelines of UTI management enable timely diagnosis of underlying malignancy. Early diagnosis of B&P RMS leads to a better prognosis, less intensive treatment, and improved quality of life of B&P RMS survivors.

None declared.
None declared.
Dasgupta R, Fuchs J, Rodeberg D. Rhabdomyosarcoma. Semin Pediatr Surg. 2016;25(5):276–283.
Ray A, Huh WW. Current state-of-the-art systemic therapy for pediatric soft tissue sarcomas. Curr Oncol Rep. 2012;14(4):311–319.
Sbaraglia M, Bellan E, Dei Tos AP. The 2020 WHO classification of soft tissue tumours: News and perspectives. Pathologica. [in press].
Ognjanovic S, Linabery AM, Charbonneau B, Ross JA. Trends in childhood rhabdomyosarcoma incidence and survival in the United States, 1975–2005. Cancer. 2009;115(18):4218–4226.
Perez EA, Kassira N, Cheung MC, Koniaris LG, Neville HL, Sola JE. Rhabdomyosarcoma in children: A SEER population based study. J Surg Res. 2011;170(2):e243–e251.
Scheer M, Dantonello T, Brossart P, et al. Importance of whole-body imaging with complete coverage of hands and feet in alveolar rhabdomyosarcoma staging. Pediatr Radiol. 2018;48(5):648–657.
Kieran K, Shnorhavorian M. Current standards of care in bladder and prostate rhabdomyosarcoma. Urol Oncol Semin Orig Investig. 2016;34(2):93–102.
Saltzman AF, Cost NG. Current treatment of pediatric bladder and prostate rhabdomyosarcoma. Curr Urol Rep. 2018;19(1):1–9.
Okarska-Napierała M, Wasilewska A, Kuchar E. Urinary tract infection in children: Diagnosis, treatment, imaging – Comparison of current guidelines. J Pediatr Urol. 2017;13(6):567–573.
Stein R, Dogan HS, Hoebeke P, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 2015;67(3):546–558.
Seitz G, Fuchs J, Sparber-Sauer M, et al. Improvements in the treatment of patients suffering from bladder-prostate rhabdomyosarcoma: A report from the CWS-2002P trial. Ann Surg Oncol. 2016;23(12):4067–4072.
Raney B, Anderson J, Jenney M, et al. Late effects in 164 patients with rhabdomyosarcoma of the bladder/prostate region: A report from the international workshop. J Urol. 2006;176(5):2190–2195.
Frees S, Rubenwolf P, Ziesel C, et al. Erectile function after treatment for rhabdomyosarcoma of prostate and bladder. J Pediatr Urol. 2016;12(6):404.e1–404.e6.
Zong X, Pole JD, Grundy PE, Mahmud SM, Parker L, Hung RJ. Second malignant neoplasms after childhood non-central nervous system embryonal tumours in North America: A population-based study. Eur J Cancer. 2017;84:173–183.
Chargari C, Haie-Meder C, Guérin F, et al. Brachytherapy combined with surgery for conservative treatment of children with bladder neck and/or prostate rhabdomyosarcoma. Int J Radiat Oncol Biol Phys. 2017;98(2):352–359.
Martelli H, Borrego P, Guérin F, et al. Quality of life and functional outcome of male patients with bladder-prostate rhabdomyosarcoma treated with conservative surgery and brachytherapy during childhood. Brachytherapy. 2016;15(3):306–311.
Jenney M, Oberlin O, Audry G, et al. Conservative approach in localised rhabdomyosarcoma of the bladder and prostate: Results from International Society of Paediatric Oncology (SIOP) studies: Malignant Mesenchymal Tumour (MMT) 84, 89 and 95. Pediatr Blood Cancer. 2014;61(2):217–222.