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.
El-Mefleh et al. (Sun,) studied this question.