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Bladder tumors

• Urothelial cell carcinoma: uncommon, present with hematuria/dysuria, manage with resection (no intravesical therapy), surveil with ultrasound (q3mo x1yr, q6mo x1yr, then annually)
• Nephrogenic adenoma: more common if recurrent infections, prior radiation or bladder surgery, appear similar to bladder cancer, require resection for diagnosis and treatment, are benign but can recur (surveillance recommended)
• Cancer in bladder augments: higher incidence than general population, but likely secondary to long-term smoking or immunosuppression

Ovarian tumors

• 98% newborns have small ovarian cysts, usually related to maternal hormones
• Adolescent ovarian cysts usually secondary to dysfunctional ovulation, manage with hormonal therapy, surgery only if persistent symptoms or concern for malignancy
• Ovarian mass: 50/50 benign/malignant
• Ovarian germ cell tumors: present with pain, distention, precocious puberty, manage with surgery and chemotherapy

Prepubertal testis tumors

• Teratoma and yolk sac tumor most common causes of childhood testis tumors
• Present with painless mass or on US for scrotal pain (rule out torsion), hydrocele present 15-20%
• US cannot differentiate benign from malignant tumors
• AFP may be falsely elevated if < 1yo
• Teratoma: US may show heterogenous complex lesion (cystic + solid), manage with partial orchiectomy, tend to be benign if prepubertal
• Epidermoid cysts: US shows layered mixed appearance, manage with partial orchiectomy
• Yolk sac: elevated AFP (marker for recurrence), 20% spread to lungs (skipping RP nodes), 20% Stage I recurrence with orchiectomy alone
• Leydig: causes 10% total precocious puberty cases, virilizing feature persist despite partial orchiectomy
• Sertoli: present with painless mass, may cause virilization/feminizaiton, manage with orchiectomy, obtain staging if > 5cm, vascular invasion, necrosis, atypia, increased mitotic activity - may require further treatment
• Partial orchiectomy: should be offered if presumed teratoma/benign tumor and confirmed with frozen section, although radical orchiectomy may be required intraop or if recurrence