Published 2023-01-10
I Made Mahandita Besut Daryanto Pradana Nurhadi


Objective: This study aims to report a case of bladder embryonal rhabdomyosarcoma in an 18-months-old boy. Case(s) Presentation: An 18-months-old boy presented with complaint of difficult urinating since the last 2 months before presentation. It was accompanied with hematuria, blood clot and palpable mass in the lower abdomen. Magnetic resonance imaging (MRI) of lower abdomen showed a solid mass in the inferior bladder wall, involved bilateral ureterovesical junction (UVJ) that caused bilateral severe hydroureteronephrosis, lymphadenopathy, and multiple nodul in both lungs. Cystoscopy was performed and found intrabladder tumor near the bladder neck and trigonum. Then biopsy of the bladder tumor was performed. Pathology result of the specimens showed bladder embryonal rhabdomyosarcoma. Then immunohistochemistry examination was performed with desmin and myogenin antibody to confirm bladder embryonal rhabdomyosarcoma diagnosis. Discussion: Bladder embryonal rhabdomyosarcoma often involves the bladder neck and trigone. In general, clinical symptoms relate to mass and blockage caused by mass. Ultrasound is the first imaging examination performed. Magnetic resonance imaging (MRI) helps depict the mass, usually hyperintense on the T2 image. The immunohistochemical examination is an important examination of skeletal muscle markers. Desmin found in muscle is used to diagnose rhabdomyosarcoma. Conclusion: Bladder embryonal rhabdomyosarcoma is a diagnostic challenge as it is a rare malignant tumor. The clinician needs to be aware of this entity and performed immunohistochemistry as an important examination to accurately diagnose embryonal rhabdomyosarcoma of the bladder. Keywords: Bladder, immunohistochemistry, rhabdomyosarcoma.



Bladder, immunohistochemistry, rhabdomyosarcoma


Emir, S., Özdemir, S. İ., Demir, H. A., Özyörük, D., Karakus, E., Tiryaki, T., & Çetindag, F. Pediatric Bladder / Prostate Rhabdomyosarcoma: Eight Cases from a Single Center. The Turkish Journal of Pediatrics. 2016; 58(3): 254.

Lott, S., Lopez-Beltran, A., Montironi, R., MacLennan, G. T., & Cheng, L. Soft Tissue Tumors of The Urinary Bladder: Part II: Malignant Neoplasms. Human Pathology. 2007; 38(7): 963-977.

Zangari, A., Zaini, J., & Gulìa, C. Genetics of Bladder Malignant Tumors in Childhood. Current Genomics. 2016; 17(1): 14-32.

Karatzas, A., & Tzortzis, V. Lower Urinary Tract Symptoms and Bladder Cancer in Children: The Hidden Scenario. Urology Annals. 2019; 11(1): 102.

Kral, M., Michalek, J., Skarda, J., Tichy, T., Smakal, O., Kodet, R., & Student, V. High-Grade Urothelial Bladder Cancer in Children: A Case Report and Critical Analysis of The Literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016; 160(4): 578-82.

WcoTE, B. WHO classification of tumours: soft tissue and bone tumours. International Agency for Research on Cancer (IARC). Lyon. 2020

Nakata, M., Hishiki, T., Sakurai, H., Saito, T., Terui, K., Mitsunaga, T., & Chikaraishi, K. Transurethral Resection for Botryoid Bladder Rhabdomyo- sarcoma. Journal of Pediatric Surgery Case Reports. 2018; 28: 37-40.

Vallasciani, S., Marrocco, G., Gulia, C., Zangari, A., & Piergentili, R. Bladder Cancer in Pediatric Patients. Bladder Cancer: Risk Factors, Emerging Treatment Strategies and Challenges. 2014: 45-69.

Russo, I., Di Paolo, V., Gurnari, C., Mastronuzzi, A., Del Bufalo, F., Di Paolo, P. L., & Milano, G. M. Congenital Rhabdomyosarcoma: A Different Clinical Presentation in Two Cases. BMC Pediatrics. 2018; 18(1): 1-5.

Heinzelmann, F., Thorwarth, D., Lamprecht, U., Kaulich, T. W., Fuchs, J., Seitz, G., & Weinmann, M. Comparison of Different Adjuvant Radiotherapy Approaches in Childhood Bladder/Prostate Rhabdomyosarcoma Treated with Conservative Surgery. Strahlen-therapie und Onkologie. 2011; 187(11): 715-721.

Priyadarshi, V., Gogoi, D., Bera, M. K., & Kumar Pal, D. Rhabdomyosarcoma of Urinary Bladder. APSP Journal of Case Reports. 2014; 5(2).

Punyko, J. A., Mertens, A. C., Baker, K. S., Ness, K. K., Robison, L. L., & Gurney, J. G. Long‐term survival probabilities for childhood rhabdomyosarcoma: A population‐based evaluation. Cancer. 2005; 103(7): 1475-1483.

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Department of Urology, Faculty of Medicine/Airlangga University