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Urethral caruncle in a 9-year-old girl: a case report and review of the literature
© Chiba et al.; licensee BioMed Central. 2015
Received: 4 November 2014
Accepted: 8 January 2015
Published: 28 March 2015
Urethral caruncles are the most frequent benign tumors of the female urethra. Most of them are found in post-menopausal women, and they are rare in childhood. Only a few pediatric cases have been published in the literature. In this report, we present an unusual case of a pediatric patient with a urethral caruncle, along with a review of the literature.
A 9-year-old Mongolian girl was referred to our hospital with a 2-week history of frequent adherence of a small amount of blood to her underwear. We found a sessile smooth margin, a clear boundary and an elastic, soft red tumor over the entire circumference of the urethral meatus. At the beginning, because of the child’s age, urethral prolapse was suspected. There was no response after 3 weeks of conservative treatment with steroid ointment. With the patient under general anesthesia, a partial tumor resection was performed for the purpose of histological examination. The tumor excision was limited to about 1/2 laps of the urethral meatus to prevent the development of urethral stricture. On the basis of clinical and histopathological examinations, a diagnosis of a urethral caruncle was made. Post-operatively, steroid ointment application to residual masses was continued, and these disappeared about 6 months later. Our patient was free of recurrence and had had no complications after 3 years of follow-up.
Urethral caruncles are rare in children, and the possibility of malignancy is slight during this period. Biopsy of the mass is not required for diagnosis. It should be indicated only if the mass has other characteristics that raise suspicion of malignancy. In previously reported cases, all of the tumor was removed. However, the trigger of the caruncle in childhood is chronic inflammation. Conservative therapy with steroid ointment should be the core treatment. However, it may be necessary to proceed to treatment because caruncles take a long time to heal. The case that we describe in this report will serve as an example for similar cases in the future.
KeywordsCaruncles Child Female Urethral
Urethral caruncles are benign and pedunculated and appear as sessile polypoid lesions of the posterior lip of the urethral meatus. They represent the most common lesion of the female urethra and occur primarily in post-menopausal women [1,2]. Only 14 pediatric cases have been published in the English-language literature to date [3-6]. In this report, we present a case of a urethral caruncle in a 9-year-old girl and review the relevant literature.
Summary of four cases reported in the literature
F/2 yr, 5mo
Posterior lip of mid-urethra/0.6cm
1 wk conservative management, complete resection
No recurrence for 2 yr
Anterior lip of urethra/1.0cm
No recurrence for 2 yr
F/2 yr, 7mo
Posterior lip of urethra/0.7cm
Granulomatous type (included intestinal heterotopia)
All around the circumference of urethra/2.0cm
3 wk conservative management, partial resection, 6 mo conservative management
No recurrence for 3 yr
The clinical differential diagnosis for a urethral or peri-urethral mass in pediatrics is urethral prolapse and peri-urethral gland abscess. Although uncommon, a spectrum of neoplasms may mimic urethral caruncle clinically, including sarcoma . Biopsy of the mass is not required for diagnosis, but it should be indicated if the mass is irregular or has other characteristics that raise suspicion of malignancy.
The management of such patients can be divided into conservative treatment and surgical resection. Conservative therapy with application of estrogen ointment is common in adults , and steroid ointment is used in children because chronic inflammation is also a trigger. In previously reported cases, short-term steroid ointment treatment was ineffective and all of the tumor was ultimately removed. Recurrences have also been seen in adult cases , but the curability of these tumors with surgical resection is high in pediatric patients. No cases of recurrence have been reported (Table 1). However, if the lesion covers the entire circumference of the urethral meatus, as in our patient, meatal stenosis after surgical excision is a potential problem . Therefore, in our patient, we restricted the surgery to a partial resection and made a pathological diagnosis after the procedure. After surgery, we used a long-term treatment period of 6 months, and the patient’s urethral caruncle was completely cured with steroid ointment. In conservative treatment, it may be necessary to proceed to treatment, considering the fact that these lesions take a long time to heal.
Urethral caruncles are rare in children, and the possibility of malignancy is slight during this period. Biopsy of the mass is not required for diagnosis. Biopsy should be indicated only if the mass has other characteristics that raise suspicion of malignancy. In previously reported cases, all of the tumor was removed. However, the trigger of caruncles in childhood is chronic inflammation. Conservative therapy with steroid ointment should be the core treatment. However, it may be necessary to proceed to treatment because these lesions take a long time to heal. Because this disease is rare in children, the treatments employed for our patient and in the other cases reported in the literature should be borne in mind when such patients are encountered. The case that we describe in this report will serve as an example for similar cases in the future.
Written informed consent was obtained from the patient’s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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