Pubertal retroareolar cysts presenting as bluish lumps: New cases and literature review.

Retroareolar cysts (RCs) are a benign self-resolving condition primarily affecting pubertal individuals. However, their presentation as asymptomatic bluish areolar lumps remains underreported in the literature, with only six cases previously documented. This lack of awareness may lead to the oversight of RCs during diagnosis. To address this, we conducted a comprehensive literature review using PUBMED, and we further added three more cases. The mean time for clinical resolution was found to be 2.3 years. In light of these findings, we proposed a diagnostic and management algorithm to guide clinicians in their approach to RCs in pediatric patients. The algorithm involves thorough clinical examination, medical history assessment, and echographic investigation with color Doppler analysis. Regular follow-up visits are recommended until resolution of the lesions. Notably, due to the consistently favorable outcome of RCs, aggressive diagnostic interventions can be avoided, providing reassurance to patients and their families. It is crucial for paediatricians to stay updated on this underreported condition to ensure timely recognition and appropriate management. Dermatologists should be the first specialists to be consulted in cases of suspected RCs. Increasing awareness among healthcare professionals will contribute to improved diagnosis and management of this benign condition. In conclusion, RCs are a benign self-resolving condition commonly observed during puberty. Their presentation as asymptomatic bluish areolar lumps may often be overlooked. Through this study, we highlighted the importance of early recognition, proposed a diagnostic and management algorithm, and emphasized the favorable prognosis of RCs, which allows for a conservative approach to their management.

Disseminated cysticercosis with multi-system involvement in a child.

We report a rare case of disseminated cysticercosis in a 7-year-old Indian girl with recent onset seizures treated with antiepileptics for 2 months. When she presented to dermatology clinic, she had multifocal subcutaneous and submucosal nodules. The subsequent diagnostic workup revealed extensive neurocysticercosis as well as orbital and myocysticercosis.

Surgical deroofing in pediatric patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory follicular disorder that most commonly involves the intertriginous areas. It is characterized by recurrent nodules that may progress into deeper abscesses and sinus tracts. Treatment is challenging and often involves a combination of lifestyle modifications, medical therapies, and procedures to control symptoms. Deroofing is a tissue-saving surgical technique that has been well studied in adults and in our clinical experience is an important adjunct therapy in pediatric patients with moderate-to-severe HS. We describe the step-by-step process of deroofing, including surgical clinical pearls specific to the pediatric population.

An unusual case of pediatric embryonal rhabdomyosarcoma with subsequent diagnosis of neurofibromatosis type 1.

A 10-month-old girl presented with a 4-month history of a rapidly growing lesion on the lower lip. Initial assessment and Doppler ultrasound supported a diagnosis of pyogenic granuloma. However, emergent biopsy revealed an embryonal rhabdomyosarcoma, a highly malignant tumor commonly associated with cancer-susceptible syndromes including neurofibromatosis type 1 (NF1). Despite having no apparent clinical features of NF1 at initial presentation, she was later found to have multiple café-au-lait spots and a subsequent diagnosis of NF1 was made.

A cross-sectional study of pediatric hidradenitis suppurativa and the value of the International Hidradenitis Suppurativa Severity Score System (IHS4) as a pediatric clinical trial inclusion criteria.

BACKGROUND: Hidradenitis suppurativa (HS) often develops in pediatrics, but few interventional studies include pediatric patients. OBJECTIVES: This dual analysis of a pediatric HS cohort and typical eligibility criteria in adult trials aims to identify potential patient characteristics and inclusion criteria for future pediatric HS studies. METHODS: This cross-sectional and descriptive study is based on a prospectively collected data registry from an HS clinic. We also queried 125 HS studies from the Clinicaltrials.gov database and information from 61 interventional systemic HS drug trials was analyzed. RESULTS: The mean abscess and inflammatory nodule (AN) count in 81 pediatric subjects was 2.3 compared to 5.0 in adults with majority being Hurley stage I (39.5%, 32/81) or II (55.6%, 45/81). Most clinical trials required patients to be Hurley stage II/III with AN count of ≥3. CONCLUSION: When developing clinical trials for pediatric HS, it is imperative to consider how baseline characteristics impact recruitment and disease assessment. Frequently used eligibility criteria in adult trials may severely limit pediatric recruitment. Although our registry had a large adult sample size, the main limitation of this study was the relatively smaller pediatric sample size.

Dirofilarial nodule as a differential diagnosis for subcutaneous lumps in children.

PURPOSE: Subcutaneous nodules in children are commonly caused by pilomatrixoma, dermoid cysts, soft tissue tumors, etc. Parasitic infections are reported to cause subcutaneous nodules and are infrequently described, mostly in the adult literature. We aim to describe the clinicopathological features of subcutaneous lumps caused by dirofilarial infestation in children in an endemic country. METHODS: A retrospective analysis was performed of all patients presenting with the above condition to Lady Ridgeway Hospital from 2018 to 2022 and their relevant details were captured in a proforma. RESULTS: There were 55 patients with a male to female ratio of 2:1. The mean age at presentation was 50 months (7-156 months). The mean duration was 97 days (1-820 days). The common sites involved were scrotum (30.9%), back (14.5%), abdominal wall (102.7%) and face (10.9%). The majority had a painless nodule (70.9%), while ten (18.2%) had features of acute inflammation. Thirty (55.5%) had preoperative ultrasonography which showed features of parasitic nodules in 26 (47.3%). Parasite was demonstrated in histopathological analysis only in 30 patients (54.5%). CONCLUSION: Dirofilarial nodule should be considered in the differential diagnosis of subcutaneous lumps in children, especially in the endemic areas.

Congenital cutaneous non-neural granular cell tumor mimicking herpetic infection: Case report and review of the literature.

We present a case of a female neonate with a cluster of six skin colored to yellowish pseudovesicular papules on her right forearm present since birth, initially thought to be a herpes simplex virus infection. Punch biopsy with immunostaining revealed a diagnosis of S100-negative, CD163-positive congenital cutaneous non-neural granular cell tumor. Only four other reports are presented in the literature of this entity, three of which also presented on the arm with somewhat similar clinical findings. We briefly reviewed the subtypes of classic and S100-negative non-neural granular cell tumors.

Posttraumatic onychoheterotopia: A case and review of the pediatric literature.

BACKGROUND: Onychoheterotopia, or ectopic nail, is a rare nail condition in which nail growth occurs in areas other than the distal phalanges. The majority of cases in the literature are noted to be congenital; however, acquired cases have less commonly been described following either acute or chronic trauma. METHODS: We present a case of acquired onychoheterotopia in a child, with a corresponding literature review of acquired pediatric onychoheterotopia cases for comparison. RESULTS: There were a total of 10 cases of acquired onychoheterotopia in pediatric patients in the literature. Including our patient, 81.8% (9/11) developed an ectopic nail on the fingers. Crush injury preceded the ectopic nails in 45.5 % (5/11) of cases. Infection occurred in 27.3% (3/11). CONCLUSIONS: Although the incidence and prevalence of acquired onychoheterotopia are unknown, it seems to be an uncommon phenomenon. From our case and others from the literature, there may be associations with crush injury specifically. Further research will be needed to fully elucidate the pathophysiology and risk factors for ectopic nail growth.

Homogeneous blue lumps of the nipple-areola complex in pubertal girls.

Retroareolar cysts are benign breast lesions caused by the obstruction and consequent dilatation of Montgomery tubercles. Herein, we report two cases of premenarchal girls who developed retroareolar cysts. Their course and differential diagnosis are discussed.

Idiopathic Facial Aseptic Granuloma in an older child: A case report in a pre-adolescent boy.

Idiopathic facial aseptic granuloma (IFAG) is an uncommon, benign lesion that presents in the pediatric population. The diagnosis is classically associated with preschool-aged children. Herein, we present a case of IFAG in a pre-adolescent boy, emphasizing the importance of diagnostic consideration in older children.

Juvenile xanthogranulomas: Examining single, multiple, and extracutaneous presentations.

BACKGROUND: Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis characterized by yellowish papules in the skin. JXGs most often occur in infancy or early childhood and are typically solitary and asymptomatic, often regressing after several years. While JXGs predominantly occur on the skin, extracutaneous JXGs also exist. AIMS: In this paper, we review the literature on single, multiple, and visceral JXGs and provide recommendations on monitoring and work-up. MATERIALS & METHODS: A literature review was conducted with the PubMed database using selective search terms for single, multiple, ocular, and visceral lesions as well as NF1/JMML. RESULTS / DISCUSSION: JXG is typically a self-limited disorder if lesions are cutaneous and singular. While rare, JXGs may manifest as multiple and extracutaneous lesions. Further screening and referral to specialists may be warranted in these cases based on age and extent of involvement. CONCLUSION: Our review demonstrates common presentations of single, multiple, and extracutaneous lesions in addition to those that occur with NF1 and JMML. We suggest patients be evaluated on a case-by-case basis by a dermatologist and referred to specialists as appropriate.

Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study.

BACKGROUND: Inadequate diagnostic evaluations of breast lumps and rectal bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of rectal bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions. OBJECTIVES: To examine processes undertaken for diagnostic evaluations of breast lumps and rectal bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion. DESIGN: A retrospective cohort study using explicit chart abstraction methods. PARTICIPANTS: Three hundred women aged 30-80 presenting with breast lumps and 300 men and women aged 40-80 years presenting with rectal bleeding to 15 academically affiliated primary care practices, 2012-2016. MAIN MEASURES: Rates and timing of test ordering and completion and patterns of visits and communications. KEY RESULTS: At initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with rectal bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p < 0.01). Most (90%) patients with breast lumps completed recommended diagnostic testing within 1 month, versus 31% of patients with rectal bleeding (p < 0.01). By 1 year, 7% of patients with breast lumps had not completed indicated imaging, versus 27% of those with rectal bleeding. Patients with breast lumps had fewer subsequent primary care visits related or unrelated to their symptom and had fewer related communications with specialists. LIMITATIONS: The study relied on documented care, and findings may be most generalizable to academically affiliated institutions. CONCLUSIONS: Diagnostic processes for rectal bleeding were less frequently guideline-concordant and timely than those for breast lumps. The largest discrepancies occurred in initial ordering of indicated tests and the timeliness of test completion.

Fibrolipomatous hamartomas not only on the soles.

Fibrolipomatous hamartomas are asymptomatic, subcutaneous lumps usually located on the infant's heels. There is wide heterogeneity in the naming of and management of this condition. Ultrasound examination permits a clear distinction from other disorders. We report herein a case of palmoplantar fibrolipomatous hamartomas.

Muscle herniation as a cause of superficial lumps on the legs of a healthy teenager.

Muscular hernias, focal protrusions of muscle through fascial weaknesses, are uncommon in pediatric patients. When diagnosed, they are usually found on the legs from protrusions of tibialis anterior muscle in young male athletes. Here, we present a case of a healthy 16-year-old boy who developed asymptomatic nodules on the bilateral feet and lateral lower legs, which were confirmed by ultrasound to be focal muscle herniations. Our case highlights a rare example of bilateral muscle herniation in a pediatric patient and the utility of ultrasound as a diagnostic modality for this uncommon condition.

Plexiform fibrohistiocytic tumor on the chest of a 5-year-old child and review of the literature.

Plexiform fibrohistiocytic tumor (PFT) is a rare neoplasm of mesenchymal origin that can be identified by its propensity for children and adolescents combined with a characteristic histologic arrangement of histiocytes and osteoclast-like giant cells whorled within tumor islands. A 5-year-old female presented with a raised, intermittently tender, and slowly enlarging tumor on her chest, which was histologically confirmed to be a PFT. We present this case along with a comprehensive review of PFT cases reported in the literature to describe the demographic, histologic, and rarely metastatic behavior of this entity. It is important to include PFT on the differential diagnosis of an enlarging tumor in the pediatric population.

Sonographic features of vaccination granulomas in children with delayed-type hypersensitivity to aluminum.

In this article, we report the sonographic features of vaccination granulomas in three children sensitized to aluminum. Although the recognition of the vaccination granuloma relies on the clinical examination, misdiagnosis is frequent, leading to distressful procedures or prolonged antibiotic administration. In all our cases, sonography revealed a teardrop-shaped echogenic central structure, suggesting the deposition of aluminum crystals along the route of administration with consequent subcutaneous degenerative changes, and a surrounding hypoechoic cap, which reflects the changeable inflammatory reaction and the granuloma formation.

Linear amyopathic dermatomyositis with calcinosis cutis responsive to topical sodium thiosulfate.

A case of a 15-year-old male patient with a 3-year history of linear, segmental amyopathic dermatomyositis with calcinosis cutis is presented. The calcinosis was recalcitrant to treatment with topical steroids and hydroxychloroquine. Topical 10% sodium thiosulfate use for 8 weeks resulted in improvement. The use of topical sodium thiosulfate for patients in whom surgical extraction is not an option is detailed.

Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder in a pediatric patient successfully treated with low-dose radiation.

Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder (PCSM-LPD) is a rare and low-grade form of cutaneous T-cell proliferation with the average age of diagnosis of 54 years. Because of its rarity, the etiology or exact clinicopathology of PCSM-LPD remains unclear, with < 10 pediatric cases reported. A 13-year-old boy presented to our clinic with a raised tumor with PCSM-LPD histology and was successfully treated with ultra-low-dose radiation therapy. While no standard of care has been established for pediatric PCSM-LPD, this report represents an example of achieving remission in a pediatric tumor with minimal potential for therapy-related long-term toxicity.

Pancreatic fat necrosis in a 10-year-old girl: A case report and review of the literature.

We report here a case of a young girl with pancreatitis and pancreatic fat necrosis (PFN). This condition is rare in the pediatric age group, and its etiopathogenesis is different from disease in adults. Whereas PFN in adults typically results from pancreatitis secondary to pancreatic duct obstruction, alcohol abuse, and pancreatic adenocarcinoma, in children it appears to arise in a setting of systemic disease, often involving a genetic disorder.