Risk for testicular germ cell tumors and spermatogenesis failure in post-pubertal undescended testes.

PURPOSE: Cryptorchidism is a well-defined risk factor for testicular germ cell tumors, whereas the underlying mechanisms have not been fully elucidated. Surgical procedures to reposition undescended testicles into the scrotum (orchidopexy) in early childhood are recommended both to increase fertility potential and to reduce the risk of developing testicular tumors. However, treatment in the post-pubertal period is controversial. The aim of this study is to review the histopathology of orchiectomy specimens and determination of spermatogenesis in post-pubertal patients with non-treated cryptorchidism. METHODS: Retrospective chart review was performed to assess the occurrence of TGCTs and determine spermatogenesis in post-pubertal individuals who underwent inguinal orchiectomy for undescended testis between January 2010 and December 2019. Age at the time of surgery, laterality, location of the undescended testis and pathology results were evaluated. All pathology specimens were reviewed by a blinded pathologist. RESULTS: There were 23 patients in the cohort with a mean age of 21 years (range 13-46 years). All testes were in the inguinal canal. Our results indicated that 1 patient had seminoma. In the histological evaluation of the remaining 22 patients in whom no tumor was detected, normal spermatogenesis was not observed in any patient. Further, seminiferous tubules were not found in 19 patients. Maturation arrest was detected in the remaining 3 patients. CONCLUSION: Testicular germ cell carcinoma was found in 4% of the patients who underwent post-pubertal orchiectomy. In addition, none of the undescended testes had normal spermatogenetic activity. Thus, orchiectomy should be considered in post-pubertal males with unilateral undescended testis that do not need the endocrinological activity of the testis.

Evaluation of Lung Ultrasonography Findings of Children With Late Respiratory System Symptoms Due to COVID-19 Infection.

Owing to coronavirus disease 2019 (COVID-19), lung damage is seen as an important problem in patients after recovery. In this study, evaluation of respiratory symptoms and lung ultrasonography (LUS) findings of those who have had symptomatic and asymptomatic COVID-19 disease in children was aimed. A total of 81 patients with positive and 18 healthy children with negative COVID-19 antibodies were included to the study. The most common late presentation symptoms were cough (85.2%), shortness of breath (77.8%), and chest pain (60.5%). In LUS, 2 or less B lines, 3 or more B lines, and Z line were seen in 66.7%, 33.3%, and 9.9% of patients, respectively. There was no significant difference between control and patients in terms of these parameters (P > .05). Pleural effusion was detected in 2 patients in the late period. Respiratory system findings may develop in the late period in patients infected with COVID-19. Therefore, patients should be followed closely.

Testicular volume loss in the long-term follow-up after surgical detorsion of the testis.

AIM: The aim of this study is to evaluate sonographic testicular volume of patients who underwent surgical detorsion due to testicular torsion and to reveal the frequency of long-term testicular volume loss and the factors affecting it. METHOD: The files of patients who underwent surgical detorsion due to unilateral testicular torsion in our hospital between 2011 and 2019 were reviewed retrospectively. Age at the time of detorsion surgery, time from the onset of pain to surgery, degree of torsion, and ultrasonographic testicular volumes before detorsion were noted. Afterward, patients with at least 6 months of follow-up were contacted by phone and testicular volumes were measured by scrotal ultrasonography (US). The sonographic formula Length × Width × Height × 0.72 was used to determine testicular volumes. RESULTS: There were 97 patients who underwent surgical detorsion within the given time frame. However, 43 of these patients accepted to be involved in the study and a follow-up scrotal US was performed. The mean age at the time of detorsion was 13.6 ± 5.6 years, whereas it was 16.7 ± 6.2 years at the time of the follow-up visit. The median time from the onset of pain to surgery was 4 h (range 1-36 h). In the preoperative US, the mean volume of the affected testis was 10.8 ± 5.6 mm3, while the mean contralateral testis volume was 10.2 ± 5.4 mm3 (p = 0.134). The median follow-up time in our study was 24 months (range 6-96 months). In the control US, the mean volume of the affected testis was 9.5 ± 7.1 mm3, while the mean volume of the contralateral testis was 14.4 ± 9 mm3 (p = 0.001). The affected testicular volumes decreased in 23 patients (range 1.1-100%), there was no change in testicular volumes in two patients, and there was an increase in testicular volumes in 18 patients (range 3.8-100%). In the ROC analysis, risk of testicular volume loss can be predicted with 87.5% sensitivity and 83.9% specificity when the time from the onset of pain to surgery exceeds 5.5 h (AUC = 0.904). CONCLUSION: Our results indicated that if the time from the onset of pain to surgery exceeds 5.5 h, the testicular volume loss may be expected in the long term. Thus, patients and parents should be informed accordingly.

PHACE Syndrome in a Child with Structural Malformations of the Brain.

PHACE syndrome is an acronym that describes a neurocutaneous condition, consisting of posterior fossa malformations that coexist with large facial hemangiomas, eye anomalies, and cardiac/aortic defects. The prognosis of the disease has not been clearly identified. There appears to be a risk of stroke in children with arterial anomalies. Radiological examinations play a considerable role in determining the degree of intracranial, cardiac involvement and the probable complications. In this article, we reported a 4-month-old boy with PHACE syndrome that has been diagnosed through a large segmental infantile hemangioma involving the eye and over the left half of the face in brain magnetic resonance imaging and magnetic resonance angiography findings. One month after starting propranolol therapy, there was a noticeable reduction in the size of the lesions. Almost complete resolution of the hemangioma was seen after a 6 months of propranolol therapy.

Comparison of computed tomography (CT) findings with RT-PCR in the diagnosis of COVID-19 in children.

AIM: This study aimed to compare chest computed tomography (CT) findings with reverse-transcription polymerase chain reaction (RT-PCR) test results in children with probable or definitive diagnosis of coronavirus disease 2019 (COVID-19). METHODS: In this retrospective archive study, pediatric patients who were followed up in the hospital with a possible or definitive diagnosis of COVID-19 and who had chest CT at presentation were included. CT scan images of the patients were reinterpreted by a pediatric radiologist and compared with their RT-PCR test results. RESULTS: Of the total of 89 patients, 33 had negative and 56 had positive RT-PCR tests. The presence of pulmonary lesions and consolidation was statistically significantly higher in the RT-PCR negative group than in the RT-PCR positive group (p = 0.037 and 0.001, respectively). Lobe involvement of 0%-25% was higher in the RT-PCR positive group (p = 0.001), and lobe involvements of 25%-50% and 50%-75% were significantly higher in the RT-PCR negative group (p = 0.001 and 0.005, respectively). Central and perihilar involvement was found to be statistically significant in the RT-PCR negative group (p = 0.008 and 0.005, respectively). CONCLUSION: Chest CT findings may provide some clues in predicting RT-PCR positivity in children with a probable diagnosis of COVID-19. Lobe involvement percentage of up to 25% is a finding in favor of patients with positive RT-PCR test, whereas 25%-75% lobe involvement, central and perihilar involvement, and consolidation can be interpreted in favor of patients with negative RT-PCR test.

Incidental ectopic adrenal cortical tissue: Retrospective analysis of 16 patients.

OBJECTIVE: To evaluate ectopic adrenal cortical tissue (EACT) and identify clinical, pathological and radiological aspects. STUDY DESIGN: Retrospective review of pathology reports in a single tertiary institution between 2010 and 2020 was conducted. Patients diagnosed with EACT were included for analysis. Demographic characteristics, accompanying pathologies and clinicopathological and radiological findings of these patients were analyzed. RESULTS: There was a total of 17 patients in the cohort. Fifteen were boys and 2 were adults (1 male). The mean diameter of the EACT nodule was 0.25 cm (range 0.2-0.5 cm). All EACTs were incidentally diagnosed. Seven EACTs were diagnosed during an inguinal hernia repair, 6 during orchidopexy, 1 during partial orchiectomy, 2 during orchiectomy and 1 during hysterectomy and bilateral salpingoophorectomy due to uterine prolapse. DISCUSSION: EACT is a rare entity that is mostly found incidentally during inguinoscrotal interventions. Radiological discrimination of EACT may not be easy and thus, not detected prior to surgery. Clinical significance of EACT is not very well understood, however it tends to be a benign pathology. Although it is more commonly found in children, adults may present with EACT, as well. CONCLUSION: A tiny yellowish nodule detected in the inguinoscrotal region should be suspected for EACT by pediatric urologists, surgeons, and pathologists.

Are urachal remnants really rare in children? An observational study.

Urachal remnants are thought to have a low prevalence. However, recent studies indicate a higher rate. The aim of this study was to evaluate the prevalence of urachal remnants in children referred for imaging by abdominal/urinary/suprapubic ultrasonography in one calendar year. Files of children who underwent abdominal/urinary/suprapubic ultrasonography in one calendar year were retrospectively reviewed. Data regarding children ≤17 years that underwent ultrasonography of the ventral abdominal wall while being assessed for various reasons were collected. Anomalies detected, age, gender, reason for ultrasonography request, and diagnosis of the urachal remnant were noted. All ultrasonography assessments were performed by a single pediatric radiologist in a single institution. There were 4836 patients in the study (1919 boys). Median age of the whole cohort was 7 years. A total of 10 patients were found to have urachal remnants, which included eight urachal cysts (three boys) and two urachal diverticula (one boy).Conclusion: The prevalence of urachal remnants in our cohort was nearly 2 in every 1000 children. More specifically, the prevalence of urachal cysts was one in 600. What is Known: • Urachal remnants were believed to be rare. • Recent studies indicated a higher incidence than previous reports. What is New: • This study shows that urachal remnant may be observed in one every 500 children that undergo ultrasonography of the abdomen for various reasons. • Parental counselling and management of urachal remnants should be planned accordingly.

Status dystonicus associated with CLN8 disease.

BACKGROUND: Status dystonicus is an underdiagnosed condition, probably due to heterogeneous etiology, presentation and course. Herein, we report the first case of CLN8 disease in the literature presenting with status dystonicus who responded well to pharmacological intervention. CASE: A boy aged five years and three months presented with fever, loss of appetite, intermittent excessive dystonic contractions, opisthotonus with retrocollis, and irritability for three days. His developmental milestones were reported as normal up to the age of three years and six months. At this age, he developed seizures, ataxia, and vision problems. Deterioration in developmental milestones was observed from the age of four. Laboratory tests demonstrated leukocytosis, abnormal renal function, mild metabolic acidosis, elevated creatine kinase and transaminase levels. The brain magnetic resonance imaging demonstrated cerebral and cerebellar atrophy. Homozygous missense mutation of c.709G > A (p.G237R) in the CLN8 gene was revealed. With all these clinical and laboratory findings, he was diagnosed with status dystonicus associated with CLN8 disease. Antibiotherapy, anticonvulsant drugs, and intravenous hydration with alkaline fluids were initiated. Due to irregular breathing, dysphagia, and worsening of dystonic contractions, mechanical ventilation was performed, and baclofen, haloperidol, midazolam infusion and chloral hydrate were administered, respectively. Finally, serum creatine kinase levels decreased, and dystonic contractions improved on the 15th day of hospitalization. CONCLUSION: To the best of our knowledge, our case is the first report describing the status dystonicus in a patient with CLN8 disease. Our report suggested that neuronal ceroid lipofuscinoses should be kept in mind in the etiology of status dystonicus.

Fibroepithelial Polyp at the Bladder Neck Presenting with Gross Hematuria in a 5-Year-Old Boy.

Background: In any age group, gross hematuria is an alarming symptom. A variety of diseases, including urinary tract tumors, urinary tract infections, glomerulonephritis, urinary stone disease, and urinary trauma, can cause gross hematuria. Neoplasms of the urinary tract are definitely the most bothersome among the differential diagnoses. Fibroepithelial polyps (FEPs), in contrast, are mesodermal-originated rare and benign tumors that can be observed in the urinary tract. In this case report, we present a child with an FEP at the bladder neck that was referred because of gross hematuria. Case Presentation: A 5-year-old boy presented with intermittent gross hematuria for 2 weeks. Ultrasonography showed a 2 × 1 cm mucosal surface-borne polypoid lesion at the trigon. Patient underwent cystoscopic evaluation that revealed a polypoid mass located at the bladder neck; however, there were no signs of bladder outlet obstruction in the bladder. Transurethral resection revealed an FEP. Conclusion: Hematuria should be evaluated carefully not only in adults but also in children. FEPs in bladder can mimic bladder carcinoma clinically and radiologically. It should be kept in mind in the differential diagnosis of bladder lesions on imaging modalities in pediatric population.