Pediatric Case Report Inflammatory Myofibroblastic Tumor of the Bladder in a 10-Year-old Girl Evren Süer, Ömer Gülpınar, Murat Mermerkaya, Berk Burgu, Pinar Celepli, Ays ¸e Sertçelik, and Tarkan Soygür Inflammatory myofibroblastic tumors (IMTs) of the bladder are rarely encountered bladder tumors during the pediatric age. The unknown malignant potential of these tumors causes controversy for their treatment and follow-up. We report a 10-year-old girl who was referred to our clinic with dysuria and enuresis. The clinicopathological evaluation was compatible with IMT and a bladder preserving approach was used. There was no recurrence in the first year of follow-up examinations. UROLOGY 80: 1138 –1140, 2012. © 2012 Elsevier Inc. B enign and malignant bladder tumors are rarely seen in childhood and can interfere with each other. Due to the difference of treatment strate- gies for these tumors, distinguishing 2 tumors is of critical importance. Inflammatory myofibroblastic tumors (IMTs) are a rare spindle tumor which is seen in every site of the body, including the bladder. 1 An absolute definition for these tumors’ malignant potential is not possible for now and the excision of these tumors with bladder preservation is the most preferred approach in the literature. 2 Herein, we report about a case of a 10-year-old girl with an IMT of the bladder who was successfully treated by a bladder preserving approach. CASE REPORT A 10-year-old girl with a 2-month history of dysuria and enuresis was referred to our department for evaluation. Previous urinalysis and urine culture tests did not dem- onstrate any pathologic finding. Physical examination demonstrated a midline, suprapubic mass with irregular contours that was palpable. An ultrasound scan showed a solid mass, mostly extravesical with an intraluminal com- ponent, which is positioned at the anterolateral surface of the bladder. The upper urinary tract was normal. For a suspected sarcoma, magnetic resonance imaging of the abdominopelvic region and a thorax computerized to- mography was performed for a complete diagnostic and staging workup. The magnetic resonance imaging revealed an ex- travesical mass measuring 46  40 mm that protruded through the bladder lumen. We did not detect further pathologic findings during the diagnostic workup. When biopsy and transurethral resection was discussed with the family, they preferred transurethral resection. Cystoscopy demonstrated a tumor at the dome of the bladder. Transurethral resection of this bladder mass was performed and specimens were obtained for pathologic evaluation. The histology demonstrated cystitis cystica and papillary epithelial hyperplasia. Because of this un- satisfactory report, an ultrasound-guided biopsy of the suprapubic mass was executed. Spindle mesenchymal cells with mixed inflammatory cell components were seen in the histopathological evaluation. Immunohistochemical staining showed spindle cells staining with anaplastic lymphoma kinase 1 (ALK-1), smooth muscle actin (SMA), desmin, calponin, and ker- atin. Myogenin staining was negative. These findings were consistent with IMT. Tumor excision with preservation of the bladder was the accepted approach for this patient because of the negative histopathological outcomes to suggest a rhabdo- myosarcoma (Fig. 1). A pfannenstiel incision was per- formed. The mass, which was situated at the dome of the bladder and the adherent peritoneal and bladder tissue, was excised. The bladder was closed and a urethral cath- eter was placed for the drainage of the bladder. On gross examination, the mass was 3  3  2.7 cm, with no capsule, not easily distinguished from the surrounding parenchyma, and light brown. There was no evidence of necrosis or hemorrhage. The histologic appearance of the lesion showed a tumor consisting of plump or spindled myofibroblasts in an edematous myxoid background with many blood vessels and an infiltrate of chronic inflam- matory cells (lymphocytes, plasma cells). Immunohistochemically, the tumor cells exhibited strong cytoplasmic positivity for SMA, vimentin, and ALK-1 (Fig. 2) and negativity for WT-1, desmin, S100, CD68, and EMA. The early postoperative period was uneventful and previous urinary symptoms recovered. In Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Urology, University of Ankara, I ˙ bn-i Sina Hospital, Sihhiye, Ankara, Turkey; and Department of Pathology, University of Ankara, I ˙ bn-i Sina Hospital, Sihhiye, Ankara, Turkey Reprint requests: Murat Mermerkaya, M.D., Department of Urology, Ankara Uni- versity, I ˙ bn-i Sina Hospital, 06110 Sıhhiye, Ankara, Turkey. E-mail: muratmer@ gmail.com Submitted: June 13, 2012, accepted (with revisions): July 16, 2012 1138 © 2012 Elsevier Inc. 0090-4295/12/$36.00 All Rights Reserved http://dx.doi.org/10.1016/j.urology.2012.07.023