title: Urethral caruncle in a 9-year-old girl: a case report and review of the literature.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan. mc-psurg@med.showa-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Chiba
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan. atoki@med.showa-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Toki
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan. akihide@mte.biglobe.ne.jp.
authors.forename: Akihide
authors.initials: A
authors.lastname: Sugiyama
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan. watanaberiejp@yahoo.co.jp.
authors.forename: Rie
authors.initials: R
authors.lastname: Suganuma
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan. colorful_tone@yahoo.co.jp.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Osawa
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Showa University School of Medicine, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan. reasonal36picture@gmail.com.
authors.forename: Rie
authors.initials: R
authors.lastname: Ishii
authors.affiliation: Children's Medical Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa-ken, 224-8503, Japan. gamigami0123@coast.ocn.ne.jp.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Nakagami
authors.affiliation: Children's Medical Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa-ken, 224-8503, Japan. mdjun@med.showa-u.ac.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Suzuki
authors.affiliation: Children's Medical Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama-shi, Kanagawa-ken, 224-8503, Japan. yuwatarai@hotmail.co.jp.
authors.forename: Yu
authors.initials: Y
authors.lastname: Watarai
authors.affiliation: Children's Medical Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Kouto-ku, Tokyo, 135-8577, Japan. s_kawano@s01.itscom.net.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Children's Medical Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Kouto-ku, Tokyo, 135-8577, Japan. sukome@ezweb.ne.jp.
authors.forename: Koumei
authors.initials: K
authors.lastname: Suzuki
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D014521:Urethra / Q000473:pathology*; D014523:Urethral Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014945:Wound Healing