[Ovarian tumors in children]. / Tumori ovarici in età pediatrica.

Ovarian tumors in children are uncommon. We reviewed all cases of ovarian tumors treated at the Department of Pediatric Surgery of Vicenza Regional Hospital from 1979 to 1994. They include 6 cases of cystic teratoma and 1 gonadoblastoma; the malignant lesions included 1 immature teratoma, 1 dysgerminoma, 1 yolk-sac tumors and 1 patient with ovarian infiltration from malignant leukemia. Only the patient with leukemia died of progression of the disease. These data show that most ovarian masses are benign. Germ-cell tumors are the most common malignancy and epithelial cell tumors are less likely. Epithelial cyst and teratomas are the most common benign lesions. Although ultrasound was 100% accurate in the diagnosis of ovarian pathology, the ultrasonogram could not distinguish between benign and malignant lesions.

[Testicular and paratesticular tumors in children]. / Tumori dei testicoli e dei tessuti paratesticolari in età pediatrica.

Testis tumors in children occur infrequently and exibit differences in their histopathology, clinical behaviour and therapy from their adult counterparts. From 1979 to 1994, 17 children and adolescent with testicular tumors were treated at the Pediatric Surgical Department of Vicenza Regional Hospital. Paratesticular rabdomiosarcoma were present in 3 cases, 4 patients had embrional carcinoma, 1 Sertoli cell tumor, 2 Leydig cell gonadal stromal tumor, and leukemic infiltrates of the testis were clinically evident in 7 patients. We report our clinical series and discuss in relation to clinical characteristic, histopathology and therapy and conclude that the improved survival during the past decade is attributable to better diagnostic imaging thecniques, the availability of serum tumor markers to monitor disease activity and more effective chemotherapy.

[Retroperitoneal nodular fasciitis: analysis of a case]. / Fascite nodosa a sede retroperitoneale: analisi di un caso.

A case of nodular fasciitis occurring in a 14-year-old girl is described and the clinical-pathological profile and the diagnostic problems are analyzed. The Authors believe this report useful to be reported for the relative rarity of the disease, especially in children, the very great dimension and the unusual retroperitoneal localization.

[Nonpalpable testis: current diagnostic and therapeutic trends]. / Il testicolo non palpabile: moderni orientamenti diagnostici e terapeutici.

Management of the nonpalpable testis often represent a significant diagnostic and therapeutic challenge for the pediatric surgeon. A variety of imaging studies may locate nonpalpable testis and include ultrasound, CT, MRI, gonadal vasography, and herniography, but none is completely reliable in locating a gonad or proving its absence. Laparoscopy has the advantage of great reliability in locating testes or proving their absence and can be coupled with surgical management; the laparoscopic findings determine the subsequent operative steps. Accurate knowledge of testis location facilitates development of an appropriate surgical strategy either laparoscopic or laparoscopic-assisted or open procedure. The Authors report their preliminary experience with laparoscopy in 30 patients (age range 2-5 years) with 34 nonpalpable testes: 18 testes were intraabdominal, 7 canalicular, 9 atrophic or absent. Out of the 18 intraabdominal testes 2 patients underwent orchiectomy (very small testes), 1 patient testis detorsion and 15 internal spermatic vessels clipping and cutting (first step of staging Fowler-Stephens orchidopexy). At the moment 8 patients, after a 8-10 months interval, underwent second staged vas-based orchidopexy with good results as judged by size and throphism of the relocated testes. An inguinal exploration has been made in 7 patients: 4 orchiectomy (hypo-atrophic testis), 3 standard orchidopexy. In 9 patients the testis were absent. In order to have a good-sized adolescent scrotal pouch, insertion of an infant-size testicular prosthesis is recommended for children with a vanishing or absent testis, if the parents agree.

[Mesenteric lymphangioma: report of a case]. / Linfangioma mesenterico: descrizione di un caso.

Lymphangiomas are benign tumours that appears to arise from congenital malformation of the lymphatics. They are most commonly reported in the head and neck regions. The clinical presentation, diagnosis and treatment of a rare case of mesenteric lymphangiomas are reviewed. Ultrasound and computed tomography are most useful in the intraabdominal cystic lesions for confirming the diagnosis. Intestinal and mesenteric resection, as soon as diagnosis is established, is the procedure of choice and results in an excellent outcome.

[True hermaphroditism in crossed testicular ectopy: report of a case]. / Ermafroditismo vero in ectopia testicolare crociata: descrizione di un caso.

Crossed testicular ectopia is a congenital anomaly characterized by the presence of both testes in the same hemiscrotum and may be associated in 20% of the cases with genitourinary developmental abnormalities. This review underscores the complexities of assessment and surgical management of an uncommon case in which crossed testicular ectopia and true hermaphroditism are simultaneously described.

[Spontaneous and traumatic rupture of the renal parenchyma in primary obstructive megaureter: a report of 2 cases]. / Rottura spontanea e traumatica del parenchima renale nel megauretere ostruttivo primitivo: descrizione di due casi.

Urinary extravasation in infants may occur secondary to a variety of congenital obstructive uropathic conditions. This condition has been reported most often in infants with posterior urethral valves and pelviureteral junction obstruction. We present two cases of perirenal urinary extravasation from the kidney due to primary obstructive megaureter. Clinical presentation, evaluation and treatment of this rare entity are discussed.

[Chondroid hamartoma of the thoracic wall: apropos of a case treated by extensive surgical exeresis]. / L'amartoma condroide della parete toracica: a proposito di un caso trattato con ampia exeresi chirurgica.

The Authors describe a case of chest wall hamartoma, very rare in infants and usually present at birth. This lesion, histologically, is benign. Surgical ablation is mandatory and curative, but the ablation of the tumor and the reconstruction of the large residual parietal defect are sometimes very difficult. In this case the surgical treatment was successful and the reconstruction of the thoracic cage was obtained with a particular surgical technique.

[A case of idiopathic mediastinal fibrosis with fatal outcome]. / A proposito di un caso di fibrosi mediastinica idiopatica ad evoluzione fatale.

Particular difficulties arise when trying to classify mediastinal fibrosis and determining its etiology and clinical evolution. In this paper, the Authors describe a case of mediastinal fibrosis which was characterized by a specific clinical origins (mild fever-anemia). It was not possible to establish the real etiology of the mediastinal lesion which in the end led to an unfavourable outcome that was linked to the local development of the illness, in spite of its benign histological characteristics.

[Interstitial-cell tumor of the testicle. A case report]. / Tumore a cellule interstiziali del testicolo. A proposito di un caso.

The authors introduce the case of a seven-years-old patient suffering from a tumor of the Leydig cells testicle, which is a pathological entity rare to be found during pediatric age. The clinical history is characterised by the absence of any endocrine phenomena, such as precocious pseudopuberty, which are usually linked to the presence of a "Leydigoma". Surgical therapy, in connection with the described constant evolution that favours such lesions during pediatric age, with the absence of any cellular anomaly which is typical of a malignant case and lastly, with the clear delimitation of the tumor from the healthy testicular parenchyma, has so far restricted itself to the enucleation alone, without orchiectomy.

[Neonatal perirenal urine extravasation and urinary ascites associated with obstructive uropathy]. / Versamento urinoso perirenale ed ascite urinosa in epoca neonatale associati ad uropatia ostruttiva.

We report two cases of perirenal urinary extravasation one of which associated with urinary ascites. An underlying congenital obstructive uropathic condition was discovered in both patients. A localised parenchymal perforation was found in both cases. Prompt treatment with correction of metabolic acidosis and decompression of the tense abdomen and the urinary tract is recommended. The patients survive in good health.

[Bilateral multicystic renal dysplasia. Description of a case]. / Displasia renale multicistica bilaterale. Descrizione di un caso.

This is a case report of a newborn with bilateral multicystic kidney; The Authors report the etiology and the histologic features of the renal multicystic dysplasia considering the role of the sonographic examination in its precocious diagnosis. Peritoneal dialysis and renal transplantation in the first year of age are dealt about as the possible current therapeutic measures in the bilateral cases.

[Hydronephrosis in childhood. Long and mid-term morphologic and functional results]. / L'idronefrosi in età pediatrica. Risultati morfologici e funzionali a medio-lungo termine.

Hydronephrosis in infancy and childhood is a frequent urinary malformation and is almost always congenital. In over 80% of the cases it is due to ureteropelvic junction obstruction; in about 17%, anomalous renal vessels at the ureteropelvic junction are present. The authors analyze their experience in the surgical treatment of hydronephrosis. 360 hydronephrosis out of 335 patients were operated on from November 1971 to November 1988. 108 patients were less than 1 year old (32.2%). Primary nephrectomy was carried out only in 11 of the 360 hydronephrosis operated on (about 3%). An anterior approach and a simple dismembering pyeloplasty were performed in the majority of the cases. From the radiological point of view there was an impressive amelioration or normalization in about 92% of the cases operated on. From the functional point of view the radionuclide scan showed a normal or slightly reduced renal function in almost 90% of the cases operated on. The preoperative and postoperative radionuclide study showed a moderate increase of the renal function in the majority of the cases controlled. The authors stress the importance of prenatal ultrasound diagnosis to improve long term results of an early surgical treatment.

[Retrotendinous ureter. An exceptional cause of obstruction in the upper urinary tract]. / Uretere retrotendineo. Una causa eccezionale di ostruzione del tratto urinario superiore.

Retrotendineus ureter is an exceptional anomaly presenting, in our experience, without clinical signs of urinary infection and obstruction. The radiological diagnosis was retrocaval ureter. The Authors report a case of a 9 years old boy who was successfully treated by ureteral section, excision of the obstructed ureteral segment and uretero-ureteral anastomosis. It seems that the case is the first reported in the medical literature of this anomaly.

[A rare cause of occult neuropathic bladder in children: the tethered cord syndrome]. / Una causa rara di vescica neuropatica occulta in età pediatrica: "the tethered cord syndrome".

The tethered cord syndrome is a form of spinal dysraphism in which a short, thickened filum terminale prevents the ascent of the conus medullaris and intraspinal lipoma causes compression upon the caudal part of the spinal cord. In pediatric age the first symptoms are urological: urinary incontinence and infection. Diagnosis is performed with urodynamic studies followed by nuclear magnetic resonance. Tethered cord syndrome is no obvious cause of a neurogenic bladder. When this pathological conditions is recognized properly and an operation is performed early the likelihood of improvement is rather high. The authors report a case of tethered cord syndrome in a girl seven years old.

[Inflammatory pseudotumor as a cause of obstructive jaundice. Report of a case in a child]. / Pseudotumore infiammatorio come causa di ittero ostruttivo. Segnalazione di un caso in età pediatrica.

Inflammatory pseudotumor involving the common bile duct, is a very rare event. The Authors were able to observe such a case in a 10 year old boy and report here the peculiar clinical findings.

[Kawasaki disease. Description of a case with atypical onset and course]. / La malattia di Kawasaki. Descrizione di un caso ad esordio e decorso atipici.

The authors, pointing out this case, intend to lay emphasis upon the possibility that, within a clinical-nosological entity complex itself, there were atypic forms (persisting pulmonary infiltration, marked hepatosplenomegaly, noticeably delayed thrombocitosis), for which only a careful estimate of all the elements permits the diagnosis.