Low grade T1 non-muscle invasive urothelial carcinoma in pediatric patient: A rare case report and management dilemma

Papillary urothelial carcinoma (UC) is rare in the pediatric population, with its presentation and etiology differing significantly from adults, posing unique diagnostic challenges. This case report describes a 10-year-old female with abdominal pain and microscopic hematuria. Ultrasonography identified a hypoechoic lesion, and subsequent cystoscopy confirmed a 1 cm exophytic tumor. Histopathology revealed a papillary UC with focal lamina propria invasion. The postoperative course was uneventful with no evidence of recurrence. Pediatric low-grade UC is a distinct entity with an excellent prognosis following complete resection. This case underscores the need to consider malignancy in the differential diagnosis of pediatric hematuria. • Diagnostic Challenge: Microscopic hematuria in a child, while often benign, warrants a complete urological evaluation to exclude rare malignancies. • Therapeutic Conservatism: Adjuvant BCG was omitted in pediatric low-grade, pT1 urothelial carcinoma due to the tumor's minimal progression risk and the therapy's significant potential side effects, creating an unfavorable risk-benefit balance. • Vigilant Surveillance: In the absence of pediatric-specific data, a cautious surveillance approach was prioritized to enable early detection of recurrence and preserve the excellent prognosis, though it must be adapted to practical realities.