1989 Volume 80 Issue 8 Pages 1218-1223
The incidence of transitional cell carcinoma (TCC) of the bladder has been increasing in men with a peak incidence occurring in the sixth decade. However, developement of tumors under the age of 30 is relatively rare. In this regard, it has been reported that vesical tumors in the young group is less malignant and rare to recur when compared with those in the elderly group. Recently, flow cytometric DNA histograms (FCM) provides quantitative and objective informations for detection and evaluation of malignant potential of bladder neoplasms. Here we report patients with tumor of the bladder under 30 years old and assess the clinical properties and biological characteristics of their tumors based on FCM. A total of 11 patients from 1975 through 1988 were reviewed Their mean age at the diagnosis was 22.6 years old (range from 22 to 29 years old). Male/female ratio was 2.7:1. The mean follow-up period was 4 years and 7 months (range from 8 months to over 13 years). An asymptomatic gross hematuria was found in all of the patients, which is the most common sign. Filling defects of the bladder on excretory urograms were observed in six out of the 11 patients (54.5%). Cystoscopically, the size of tumors was less than 2cm in diameter. Ten patients had a single tumor and one patient had multiple tumors at the time of the initial diagnosis. Endoscopically tumors were papillary in all but one patient, who had a non-papillary tumor. Their urine cytology showed class I in one, class II in eight, class III in one, class IV in one and class V in none. The stage of the tumors at the initial diagnosis was stage A in all patients and the grade of the tumors was grade I in four and grade II in seven. All patients underwent transurethral resection of the tumor and instillation therapy followed with mitomycin C in three, BCG in one, thiotepa in one and cytarabine in one. Recurrent tumor developed 10 months after transurethral resection of the tumor in only one patient. FCM analysis of bladder biopsy and irrigation specimens were performed in six patients. Two out of six biopsy spicemens (33.3%) and three out of six bladder irrigation specimens (50%) showed distinct aneuploid patterns.
These results indicate that some bladder tumors occurring in young patients express the potentiality for an aggressive disease when assessed by flow cytometric DNA-histograms, despite the overall benign nature of the disease. Therefore, a long-term follow-up is necessary in these patients.
