Neuroblastoma arising from an unresected sacrococcygeal teratoma in a child.

Malignant transformation of a germ cell tumor, referring to the occurrence of somatic, nongerm cell malignancy within a germ cell tumor is a rare entity. The authors report a case of malignant transformation of an unreseceted sacrococcygeal teratoma to neuroblastoma in a 6-year-old girl and discuss this case in the light of relevant literature. This case shows that complete resection of germ cell tumor is necessary to prevent malignant transformation. In addition, when malignant transformation occurs, the treatment strategy must include surgery together with histology adapted systemic chemotherapy.

Investigation of histopathologic changes in pelviureteral junction obstruction.

OBJECTIVES: This study aimed to determine histopathologic changes in the pelviureteral junction in children with pelviureteral junction obstruction. MATERIAL AND METHODS: Seventeen pelviureteral junction specimens obtained from children were divided into two groups: pelviureteral junction obstruction (n = 7) and control (n = 10). Wall thickness of the pelviureteral junction, tunica muscularis of the pelviureteral junction, uroepithelium thickness of the pelviureteral junction, and collagen thickness of the pelviureteral junction were evaluated in resected pelviureteral junctions in children with pelviureteral junction obstruction. MAIN FINDINGS: The mean wall thickness of the pelviureteral junction, mean tunica muscularis of the pelviureteral junction, and uroepithelium thickness of the pelviureteral junction were not significantly higher than those in the control group. Collagen thickness values in the pelviureteral junction obstruction group were significantly higher than those in the control group. CONCLUSIONS: Our data suggest that wall thickness (tunica muscularis and uroepithelium) was not significantly increased, but collagen thickness of the ureter was increased in the pelviureteral junctions of children with pelviureteral junction obstruction.

A rare presentation of true hermaphroditism: an abnormal inguinoscrotal mass.

This study examined the differential diagnosis of inguinoscrotal masses and true hermaphroditism as well as incarcerated inguinal hernia in the differential diagnosis of abnormal inguinoscrotal masses. Inguinoscrotal masses are a rare presentation of true hermaphroditism. A child with an inguinoscrotal mass of the right groin and penoscrotal hypospadias was diagnosed. Our case suggested that abnormal inguinoscrotal masses occur in true hermaphroditism as well as incarcerated inguinal hernia. These congenital anomalies should be considered in the differential diagnosis of inguinoscrotal masses of the groin.

Local effects of epidermal growth factor on the wound healing in esophageal anastomosis: An experimental study.

OBJECTIVE: In this study with the experimental model of primary repair of esophageal atresia(EA), we investigated the effects of the epidermal growth factor(EGF) on wound healing in the anastomosis of EA. MATERIALS AND METHODS: Forty rabbits that were performed a resection of a 1-cm segment of the cervical esophagus followed by the end-to-end anastomosis were divided into four groups. Group I (7-day group) and III (21-day group), the control groups, had no EGF applied to the anastomosis. In group II (7-day group) and group III (21-day group), all around the anastomoses were locally covered with 100 µg/kg EGF. Group 1, 2 and 3, 4 were sacrificed on the 7th and 21st day, respectively. We investigated and compared with bursting pressure, vascularization around the anastomotic line by histopathology, inflammation, and fibroblast granulation as well as hydroxyproline level by biochemical. RESULTS: No significant difference was found at vascularization and inflammation between all of the groups (p > 0.05). Considering the critical parameters of the groups, at bursting pressure difference was found between group 1 and 2 as well as 3 and (p < 0.05). At fibroblast granulation and hydroxyproline level, no difference was found between group 1 and 2 (p > 0.05) but the difference between group 3 and 4 (p < 0.05). CONCLUSION: EGF might be useful in preventing anastomotic leakage of esophageal atresia in primary anastomosis of esophageal atresia by accelerating wound healing process and increasing the stability of the anastomotic line.

Frequency of pharyngeal reflux in children with adenoid hyperplasia.

OBJECTIVES: The purpose of the study is to investigate whether there is any association between pharyngeal reflux and adenoid hyperplasia by using 24-h esophageal pH monitoring with a dual probe in children. METHODS: The study group consisted of 30 children with adenoid hyperplasia, and the control group consisted of 12 healthy children, studied prospectively. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring). The results were evaluated by the Measurement and Analysis Software of Medical Measurement System program (Version: 7.2a). RESULTS: In the study group, the frequency of pharyngeal reflux was 46.7% and the gastroesophageal reflux (GER) was 64.5%, while, in the control group, they were 8.3% and 25%, respectively. There was a significant difference between study and control groups for frequencies of pharyngeal reflux and GER. Mean adenoid nasopharyngeal ratio (ANR) was 0.78+/-0.11 in children with adenoid hyperplasia. There was not a significant difference between positive pharyngeal reflux, positive GER and mean ANR (p>0.05). CONCLUSIONS: Children with adenoid hyperplasia had higher frequency of pharyngeal reflux than children at the same age healthy group. These results supported that pharyngeal reflux may play an important role in the etiology of adenoid hyperplasia.

Pharyngeal reflux in children with chronic otitis media with effusion.

OBJECTIVE: To investigate whether there is an association between chronic otitis media (COM) with effusion and pharyngeal reflux in children by using 24-h pH monitoring with a dual probe. MATERIAL AND METHODS: This was a prospective study. The study group consisted of 25 children with COM with effusion and the control group comprised 12 healthy children. All children underwent 24-h esophageal pH monitoring with a dual probe (distal and proximal esophageal pH monitoring). RESULTS: In the study group, the frequencies of pharyngeal and gastroesophageal reflux (GER) were 48% and 64%, respectively, and the corresponding values in the control group were 8.3% and 25%. Both of these differences were significant (p <0.05). In the study group, 28% of patients were positive for at least 1 symptom of GER; 72% of the patients did not have any symptoms but 56% of these patients had silent GER. CONCLUSIONS: These findings indicate that pharyngeal reflux may play an important role in the etiology of COM with effusion. If patients have typical symptoms of GER, such as pyrosis, regurgitation, dysphagia and emesis, the presence of GER should be considered. The presence of silent GER and pharyngeal reflux should also be considered.

Coexistence of glomangioma and yolk sac tumour in a child: a case report.

Glomus tumours (GTs) primarily arise from glomus bodies that are located in the dermis layer of skin. However, they can be encountered ectopically in most parts of the body. As a result of researches done in a 17-month-old male patient who prssented to us with complaint of an increasingly growing swelling, he was diagnosed with a yolk sac tumour. Chemotherapy was started and then, he was operated. GT was found inside the tumoural mass. Our patient, who is the first case according to our knowledge, where the concurrence of yolk sac and glomus tumours was reported, has been discussed in the light of literature.

Colon agenesis with ileovesical fistula and anorectal malformation.

Colonic agenesis is a rare cause of congenital bowel obstruction and is usually associated with other malformations such as abdominal wall defects or gastrointestinal, cardiac, urogenital, and musculoskeletal lesions. Although many uncommon types have been reported, ileovesical fistula (IVF) associated with total colonic agenesis (TCA) has not been reported in a newborn with anorectal malformation (ARM). This is the first report of a 1-day-old newborn with ARM, IVF, and TCA.

Investigation of histopathologic changes in the ureter walls in vesicoureteral reflux.

PURPOSE: This study aimed to determine the histopathologic changes in ureteral walls (UWs) in children with vesicoureteral reflux (VUR). METHODS: Twenty ureteral specimens taken from children were divided into 2 groups, refluxing (R) and control (C) groups, each containing 10 specimens. Wall thickness of the ureter, tunica muscularis of the ureter, mucosal thickness of the ureter (uroepithelium), collagen thickness of the ureter, mucosal change, and inflammation were evaluated in resected distal UWs in children with VUR. RESULTS: The mean wall thickness of the ureter, mean tunica muscularis of the ureter, and mean uroepithelium values of the UWs in the R group were not significantly lower compared to those in the C group. Collagen thickness values in the R group were significantly lower than those in the C group. CONCLUSIONS: Our data suggest that wall thickness (tunica muscularis and uroepithelium) was not significantly decreased, but collagen thickness of the ureter was decreased in the UWs of children with VUR.

Effects of fasting and preoperative feeding in children.

AIM: To investigate whether children should undergo surgery without a long period of fasting after feeding. METHODS: Eighty children with inguinoscrotal disorders (aged 1-10 years) were studied prospectively. They were divided into eight groups that each contained 10 children who were fed normal liquid food (NLF) and a high-calorie diet (HCD) 2, 3, 4 and 5 h before surgery, in two doses at 6-h intervals. NLF was given to four groups and HCD to the other four. In all groups, glucose, prealbumin and cortisol levels in the blood were measured twice: just after oral feeding and just before the operation. After the establishment of adequate anesthesia, gastric residue liquid was measured with a syringe. RESULTS: Blood glucose levels in all patients fed NLF and HCD were high, except in patients in the HCD-4 group. There was no significant difference in the blood prealbumin levels. There was a significant increase in the blood cortisol levels in the NLF-2 (14.4 +/- 5.7), HCD-2 (13.2 +/- 6.0), NLF-3 (10.9 +/- 6.4), and HCD-5 (6.8 +/- 5.7) groups (P < 0.05). CONCLUSION: The stress of surgery may be tolerated by children when they are fed up to 2 h before elective surgery.

Investigation of histopathologic changes in the ureter walls in experimental congenital obstructive uropathy.

BACKGROUND/PURPOSE: The aim of this study is to determine the histopathologic changes in the ureter wall in experimental urinary bladder hypoplasia and agenesis. METHODS: Timed pregnant rats were randomly divided and received intraperitoneal Adriamycin (ADR) at 2 mg/kg on gestational days (GD) 6 to 9 (ADR group) and saline at 2 mL/kg on GD 6 to 9 (SF group). The control (C) group did not receive any medication in their pregnancy. Fetuses were harvested near term on GD 21 and dissected under a dissecting microscope and examined for urinary system abnormalities. RESULTS: Diameter of ureter lumen was significantly increased, but wall thickness, tunica muscularis, and epithelial thickness of the ureter were decreased in the ADR group as compared with the C and SF groups. CONCLUSIONS: Diameter of the ureter lumen was increased, but wall thickness, tunica muscularis, and uroepithelium of the ureter were decreased in the ADR group in the intrauterine period. The diameter of the ureter lumen and wall thickness of ureter (tunica muscularis of ureter and uroepithelium) were increased following obstructive uropathy after the birth.

Mesenchymal hamartoma of the liver mimicking hepatoblastoma.

Mesenchymal hamartoma of the liver is a cystic benign liver mass occurring in children. Diagnostic confusion with hepatoblastoma may arise when alpha-feto-protein (AFP) level is elevated. We report an extremely rare case of mesenchymal hamartoma in an 11-month-old boy. Serum AFP was elevated and fine-needle aspiration biopsy suggested the lesion as hepatoblastoma, so he received preoperative chemotherapy. At the end of the preoperative chemotherapy, the tumor size and AFP level decreased. A right hepatectomy was performed. The pathologic examination of the specimen revealed mesenchymal hamartoma. Mesenchymal hamartoma of the liver with increased serum AFP levels may mimic hepatoblastoma if a cytological examination samples only the hepatocellular component of mesenchymal hamartoma. According to our knowledge, this is the first case of the mesenchymal hamartoma of the liver, which showed reduction in serum levels of AFP and involution of the tumor size by preoperative chemotherapy.

Spermatic cord hydatid cyst: an unusual localization.

Lesions of the groin include hernia, hydrocele, spermatic cord cyst, undescended testes, lymphadenopathy, and abscess. Hydatid cysts are endemic in certain regions of the world. They are usually located in the liver, lung, spleen, brain, and kidney. Although many uncommon locations have been reported, hydatid disease has been reported 3 times in the spermatic cord. This is the first report of a child with hydatid disease in the spermatic cord. A 9-year-old boy with a spermatic cord cyst proven to be a hydatid cyst is reported.

Hepatoblastoma in a child with neurofibromatosis type I.

A major hallmark of NF1 is the development of benign tumors, including peripheral neurofibromas, plexiform neurofibromas, gliomas of the optic tract, other low grade gliomas, and pheochromocytomas. Hepatoblastoma have not been previously reported in patients with neurofibromatosis type 1. We present a case of a 9-month-old boy diagnosed with both hepatoblastoma and neurofibromatosis type 1. Hepatoblastoma occurs in association with several well-described cancer predisposition syndromes, including familial adenomatous polyposis, Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, trisomy 18, and glycogen storage disease type I. This paper describes a case of hepatoblastoma diagnosed in association with neurofibromatosis type 1.

Effect of antioxidant therapy on collagen synthesis in corrosive esophageal burns.

To investigate the efficacy of antioxidant therapy on collagen synthesis in corrosive esophageal burns, 110 Sprague-Dawley rats were divided into five groups of 22 animals each. A standard esophageal caustic burn was produced by 1 ml of 10% sodium hydroxide solution for the rats in groups B to E; group A was instilled only with 0.9% saline after preparation of the distal esophageal segment. Group A animals (controls) were uninjured and untreated. Group B had untreated esophageal burns. Esophageal burns were treated in group C with vitamin E (10 mg/kg IM), in group D with vitamin C (10 mg/kg IP), and in group E with methylprednisolone (30 mg/kg IM) on each of 5 days. Eight rats from each group were killed 4 days after initiation of the study and the abdominal esophagus was studied for tissue malondialdehyde (MDA; micromol/g protein) levels. The other rats were killed 28 days after initiation of the study and determination of hydroxyproline (HP) (microg/g tissue) levels in esophageal tissue was performed for 8 rats in each group. Histopathologic evaluation was also performed in the other 6 rats from each group. MDA levels in esophageal tissue were significantly lower in groups C (9.24 +/- 2.62, P < 0.01) and group E (6.26 +/- 2.22, P < 0.001) than in group B (12.35 +/- 1.80). HP levels were significantly lower in groups A (0.75 +/- 0.21, P < 0.001), C (1.11 +/- 0.15, P < 0.01), and E (0.96 +/- 0.15, P < 0.001) than in group B (1.40 +/- 0.20). Histopathologically, collagen deposition in the submucosa and tunica muscularis was lower in groups C and E than in group B (P < 0.05, and 0.01, respectively). Our results demonstrate that treatment with antioxidant drugs such as vitamin E and methylprednisolone decreased tissue HP levels, and thus inhibited new collagen synthesis and stricture formation in rats with alkali-induced caustic esophageal burns.

Intestinal ischemia-reperfusion and plasma enzyme levels.

Determination of blood levels of intracellular enzymes is an appropriate method to evaluate tissue and organ damage. To show systemic tissue damage resulting from intestinal ischemia-reperfusion, New Zealand rabbits underwent 60 min intestinal ischemia and 60 min reperfusion. Plasma samples were obtained before and at 55, 70, and 120 min after operation and enzyme levels were determined. Plasma aspartate aminotransferase (AST) showed a significant increase during reperfusion while lactate dehydrogenase (LDH) and creatine kinase (CK) levels were significantly increased at the end of ischemia and continued to be so throughout reperfusion. It is difficult to claim that enzymes arise from the intestine, but an increase of CK, LDH, and later of AST without any increase in alanine aminotransferase levels during ischemia suggests that their primary source is the injured intestine. Increased levels of plasma enzymes do not provide exact information about the location, but do reveal the presence of an injury.

Galactorrhea-associated granulosa cell tumor in a child.

Granulosa cell tumor of the ovary is a rare form of ovarian cancer in children. An 11-year-old girl was admitted with complaints of galactorrhea and abdominal mass. Abdomino-pelvic ultrasound and computed tomography revealed an ovarian tumor. Her prolactine and estradiol levels were increased but luteinizing hormone and follicle-stimulating hormone were decreased. An exploratory laparotomy revealed a giant solid mass, which was completely removed and determined as juvenile granulosa cell tumor. The clinical, hormonal, and radiological findings and the therapy of galactorrhea associated with granulosa cell tumor in a child are discussed. To our knowledge, this is first time it has been described in childhood.