A Giant Pedunculated Urothelial Polyp Mimicking Bladder Mass in a Child: A Rare Case

Ureteral fibroepithelial polyps are rarely seen benign tumors with mesodermal origin. These polyps can involve kidney, pelvis, ureter, bladder, and urethra. The most common symptoms are hematuria and flank pain. The choice of treatment is either endoscopic or surgical resection of polyp by sparing kidney. Here, we presented a pediatric case with giant, fibroepithelial polyp that mimics bladder tumor, originating from middle segment of the ureter. 1. Introduction Ureteral fibroepithelial polyp (UFP) is a rarely seen benign tumor of mesodermal origin in infants and children [1]. Fibroepithelial polyps are associated with symptoms related to obstruction of urinary tract. The most common symptoms are hematuria and flank pain [2]. Most UFPs are observed in ureter, while 15% of UFPs are seen in renal pelvis and, less commonly, at urethra and bladder [3]. The management is simple or segmental resection with end-to-end anastomosis. Ureteroscopic excision is a less invasive and widely used alternative when compared to open surgery [2, 3]. Incomplete resection of polyp may result in tumor recurrence after surgery. Here, we present a 14-year-old boy who presented with hematuria and had a giant fibroepithelial polyp with ureteral origin that mimics bladder tumor. To the best of our knowledge, no pediatric case with a ureteral fibroepithelial polyp in such extent that mimics bladder mass has been reported so far. 2. Case Report A 14-year-old boy was admitted to hospital with hematuria. Results of complete blood count and biochemical test were within normal range. There was hematuria in urinalysis, but urine culture evaluation was sterile. There was no abnormal finding in his history. On abdominal sonography, a lobulated, hypoechoic mass (40 × 28？mm in size) at posterolateral wall of bladder extending to lumen was observed. On Doppler sonography, vascularization was observed at the area of mass. On CT scan, a suspicious lesion (3.5 × 3？cm in size) was observed at left posterolateral wall of bladder (Figure 1). No enlargement in lymph nodes or finding favoring metastasis was observed in the pelvic region and abdomen. Figure 1: On contrasted CT, a suspicious lesion with thin septa was observed at posterolateral wall of bladder (3.5 × 3？cm in size). On cystoscopy, a vegetative mass (approximately 5 × 6？cm) that protruded into bladder through a stalk (Figure 2) was observed at left orifice of bladder. In the same session, ureterorenoscopic assessment was performed which revealed that the stalk extended to middle segment of ureter. However, it was failed to observe where