RESUMO
Leukemia is the most common childhood malignancy and often presents with nonspecific symptoms. Occasionally, it presents with extramedullary manifestations, which have been more frequent in cases of myeloid lineage or T cells. However, precursor B-cell leukemia/lymphoblastic lymphoma can also have extramedullary manifestations in some patients. Describing certain clinical features along with diagnostic imaging can establish a presentation pattern and suggest a diagnosis in the pediatric population. Herein, we present a series of four patients with extramedullary manifestations of B-cell lymphoblastic leukemia, describing their clinical imaging and histopathological characteristics.
RESUMO
The megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS), also known as Berdon syndrome, is a rare congenital condition that falls within the spectrum of visceral myopathies. It is characterized by the presence of megacystis, microcolon, and hypoperistalsis, which are secondary to gastrointestinal and urinary system dysmotility. It is frequently associated with other alterations in the gastrointestinal and genitourinary tracts. Although it is possible to make the diagnosis in the prenatal period, most cases are diagnosed after birth through genetic and imaging studies. Advances in treatment have led to a progressive increase in survival rates. We present the case of a newborn with congenital alterations described prenatally and with imaging findings characteristic of the syndrome.
RESUMO
We present a case of an eight-month-old girl who was brought to the emergency department with bloody stools. An initial ultrasound reported a mass in the left iliac fossa that was further characterized by magnetic resonance imaging (MRI) as a hypervascular ovarian tumor. Prior to surgical resection of the tumor, abdominal arteriography with selective embolization and vessel occlusion was performed. Pathology reported epithelioid hemangioendothelioma of the left ovary. This condition has not been previously reported in girls. In this case report, we describe the ultrasound, MRI, and arteriographic findings with a histopathologic correlation of an adnexal tumor that is unknown in the pediatric female population until now.
RESUMO
Abstract Introduction: Identifying the imaging features of renal tumors in pediatric population allows reaching more accurate diagnoses and implementing more appropriate treatments. Objective: To describe the imaging findings of renal tumors in children and to assess the association between imaging findings and histological diagnosis of Wilms tumors versus Non-Wilms tumors, and between imaging features and intraoperative rupture of Wilms tumors, as well as the level of agreement between radiological and histological diagnosis (Wilms vs. Non-Wilms tumor). Materials and methods: Cross-sectional study conducted in 47 children with a pathological diagnosis of kidney tumor and treated between 2012 and 2018 in a pediatric hospital in Bogotá D.C., Colombia. The patients' medical records, as well as their ultrasound, tomography and magnetic resonance studies were reviewed. Two univariate logistic regression analyses were performed to assess the association between imaging findings and histopathological diagnosis and between imaging features and intraoperative rupture of Wilms tumors, calculating the respective Odds Ratio (OR) with a 95% confidence interval. In addition, the level of agreement between radiological and histological diagnosis was determined using the Cohen's kappa coefficient. Results: A significant association was found between histological diagnosis of Wilms tumor and the presence of necrosis, tumor enhancement, pseudocapsule, rupture signs, tumor volume and tumor size (OR: 21.6, 15.17, 14.57, 8.21, 7.93, and 4.37, respectively; p<0.05). An association between having Wilms tumors and a lower frequency of metastases was also found (OR: 0.19; p<0.05). The kappa coefficient between radiological diagnosis of Wilms/non- Wilms tumors and histological diagnosis was 0.78 (CI95%: 0.59-0.96; p<0.05). Additionally, Wilms tumors volumen was significantly associated with the occurrence of rupture (OR: 3.08; p<0.05). Conclusions: There are imaging findings such as necrosis, tumor enhancement and tumor volume that can help predict the histological diagnosis of Wilms tumors, as well as perioperative rupture. In addition, a moderate to very good concordance between radiological diagnosis of Wilms/non-Wilms tumors and histological findings was found.
Resumen Introducción. Identificar las características por imagen de los tumores renales en la población pediátrica permite realizar diagnósticos más precisos e implementar tratamientos más apropiados. Objetivo. Describir los hallazgos de imagen de tumores renales en niños y evaluar la asociación entre hallazgos imagenológicos y el diagnóstico histopatológico de tumores de Wilms versus tumores no Wilms, y entre las características de imagen y ruptura quirúrgica de tumores Wilms, así como el grado de concordancia entre el diagnóstico radiológico e histológico. Materiales y métodos. Estudio transversal realizado en 47 niños con diagnóstico patológico de tumor renal atendidos entre 2012 y 2018 en un hospital pediátrico de Bogotá D.C., Colombia. Se revisaron las historias clínicas de los pacientes, así como sus estudios de ultrasonografía, tomografía y resonancia magnética. Se realizaron dos análisis de regresión logística univariados para evaluar la asociación entre hallazgos imagenológicos y diagnóstico histopatológico y entre las características imagenológicas de los tumores de Wilms y ruptura quirúrgica, calculando los respectivos odds ratio (OR) con un intervalo de confianza del 95%. Además, se determinó el grado concordancia entre el diagnóstico radiológico e histopatológico mediante el coeficiente de kappa de Cohen. Resultados. Se encontró una asociación significativa entre el diagnóstico histológico de tumor de Wilms y la presencia de necrosis, realce tumoral, pseudocápsula, signos de ruptura, volumen y tamaño del tumor (OR: 21.6, 15.17, 14.57, 8.21, 7.93 y 4.37, respectivamente; p<0.05). También se observó una asociación entre tener tumores de Wilms y menor frecuencia de metástasis (OR:0.19; p<0.05). El coeficiente de Kappa entre el diagnóstico radiológico de los tumores (Wilms/no-Wilms) y el diagnóstico histológico fue 0.78 (IC95%: 0.59-0.96; p<0.05). Además, el volumen de los tumores de Wilms se asoció significativamente con la ocurrencia de ruptura (OR: 3.08; p<0.05). Conclusiones. Hay hallazgos imagenológicos como la necrosis, el realce tumoral y el volumen tumoral que ayudan a predecir el diagnóstico histológico de tumores de Wilms, así como la ruptura perioperatoria. Además, se observó una muy buena concordancia entre el diagnóstico radiológico de tumores Wilms/no Wilms y los hallazgos histológicos.
RESUMO
Objetivos: Establecer la asociación de vasoespasmo cerebral detectado por Doppler transcraneal y la condición clínica, de acuerdo con la escala de la Federación Mundial de Sociedades de Neurocirugía, y con otros factores de riesgo en pacientes con hemorragia subaracnoidea espontánea. Materiales y métodos: Estudio observacional retrospectivo de casos y controles, con 141 pacientes diagnosticados con hemorragia subaracnoidea espontánea a quienes se les realizó Doppler transcraneal de seguimiento entre el 8 de marzo de 2011 y el 15 de marzo de 2015. Del total de pacientes se escogieron 47 con vasoespasmo detectado por Doppler transcraneal y 2 controles, sin vasoespasmo, por cada caso (94 pacientes). En las historias clínicas y las imágenes de los pacientes se estableció la asociación entre la detección de vasoespasmo por Doppler transcraneal con la condición clínica neurológica en el momento del examen, y otros factores de riesgo. Para el análisis de las variables cualitativas se utilizaron frecuencias absolutas y relativas. Para variables cuantitativas se utilizó la prueba de Shapiro Wilk. Los datos con distribución normal se presentan con medias y desviaciones estándar y aquellos sin distribución normal con medianas y rangos intercuartiles. Se evaluó la homogeneidad entre los dos grupos a través de la prueba de Chi cuadrado y el test de homogeneidad de varianzas (Levene) de acuerdo con el tipo de variable. Se consideró estadísticamente significativa una p ≤ 0,05. Resultados: El análisis bivariado no demostró resultados estadísticamente significativos en la relación entre la condición clínica neurológica y el vasoespasmo, pero sí encontró que pacientes menores de 50 años de edad presentaron más vasoespasmo (OR de 3,55 [95 % IC; 1,52-7,39]), y p: 0,003 que los de mayor edad. Conclusiones: Los pacientes menores de 50 años de edad tienen más riesgo de desarrollar vasoespasmo y no existe asociación entre la condición clínica y los resultados del Doppler transcraneal.
Objectives: Establish the association between cerebral vasospasm, detected by transcranial doppler, with the clinical condition according to the scale of the World Federation of Neurosurgical Societies (WFNS) and other risk factors in patients with spontaneous subarachnoid hemorrhage. Materials and methods: This is an observational retrospective case-control study, including 141 patients with a diagnosis of spontaneous subarachnoid hemorrhage who underwent transcranial doppler monitoring in the radiology department of the University Hospital San Vicente Foundation (HUSVF) from 8 March 2011 to 15 March 2015. Of the total number of patients with subarachnoid hemorrhage, 47 cases with vasospasm, detected by transcranial Doppler, and two controls without vasospasm (94 patients) were consecutively chosen. Subsequently, we review the medical records and images stored in the hospital´s radiology department and established the association between vasospasm detection by trasncranial Doppler with clinical neurological status at the time of the study and other risk factors. For the analysis of the qualitative variables, absolute and relative frequencies were used. Quantitative variables were tested for normal distribution with a Shapiro Wilk test. Data with normal distribution were presented with means and standard deviations and those without normal distribution with medians and interquartile ranges. Homogeneity between the two groups were evaluated by Chi-square test and test for homogeneity of variances, Levene's test, according to the type of variable (qualitative and quantitative respectively). Results were considered statistically significant if p ≤ 0.05. Results: Data from 141 patients (47 cases and 94 controls) were analyzed. The bivariate analysis didn´t show statistically significant results in the relationship between vasospasm and clinical neurological condition but found that patients younger than 50 years had more vasospasm. In the adjusted model for patients with this age, the OR was 3.55 (95 % CI, 1.52-7.39) and p: 0.003 when compared with older patients. Conclusions: This study found that patients under 50 have a higher risk of developing vasospasm compared with older patients and that there is no association between clinical condition and the results of transcranial Doppler.
