Cranial fasciitis presenting as an intracranial mass in a 10-year-old girl

Cranial fasciitis is a mass-forming lesion of myofibroblastic proliferation of the skull and overlying soft tissue and occurs most frequently in pediatric patients. Cranial fasciitis has the same histological features as nodular fasciitis, which appears in the subcutaneous tissue in other parts of the body. Cranial fasciitis can involve the outer table of the skull, and it occasionally extends through the skull to form a mass involving both soft tissue and the epidural space. Intracranial cranial fasciitis without a soft tissue mass is extremely rare. Here, we report a case of a 10-year-old girl who presented with a massive intracranial mass that caused midline shift of the brain. The lesion showed focal areas of osseous metaplasia and a cytogenic abnormality of t(17;18)(q25∶q12.2) that have not yet been reported.     

Hyperostotic meningioma presenting as an asymptomatic forehead bulge in a 7-year-old girl

The case of an asymptomatic 7-year-old girl with a hard bulge in the left forehead is presented. The radiological evaluation disclosed a hyperostotic mass with a large intracranial extension. A surgical specimen revealed a meningioma. The presence of a localized cranial bulge as the only sign of an intracranial tumor and the diagnostic value of computerized tomography (CT) are discussed.Abbreviation CT computerized tomography     

Gastric adenocarcinoma presenting as thrombotic microangiopathy in a 14-year-old girl

Gastric adenocarcinoma is rare in childhood and often presents with disseminated malignancy at diagnosis due to aspecific symptoms leading to delay in diagnosis. A familial predisposition for gastrointestinal cancer is suggested for the development of this early-onset adenocarcinoma. We report the case of a 14-year-old girl with a familial history of colorectal, liver, and breast cancers affected by metastatic gastric adenocarcinoma, who first presented with thrombotic microangiopathy. Thrombotic microangiopathy as first clinical presentation of metastatic gastric cancer is an exceptional event in childhood and represents a challenge for pediatricians. Gastric adenocarcinoma should be suspected in young patients with a significant familial history and also in the absence of initial specific signs, so as to provide correct diagnosis and appropriate treatment.     

Hydroxyapatite deposition disease presenting as calcific periarthritis in a 14-year-old girl

We report a case of hydroxyapatite deposition disease presenting as acute periarthritis in a 14-year-old girl with typical radiological features and clinical course. We also review the clinical and laboratory features to increase awareness of this entity.     

Massive low-grade fibromyxoid sarcoma presenting as acute respiratory distress in a 12-year-old girl

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue sarcoma that usually presents in young adults as a painless, slow-growing mass. Evans first described LGFMS in 1987 as a spindle-cell sarcoma with bland histological features and paradoxically aggressive behavior. Although young adults are most frequently affected, recent reports describe pediatric cases being increasingly more common. Males and females are affected approximately equally and common locations include the deep soft tissue of the lower extremity, particularly the thigh and trunk. Primary occurrence within the chest cavity is exceedingly rare. Local recurrence and metastasis are not uncommon and present the clinician and radiologist with challenges regarding follow-up recommendations. Review of the literature reveals many cases of slowly progressive symptoms related to a mass effect. We present a healthy 12-year-old African-American girl who interestingly developed acute symptoms of shortness of breath and chest pain while playing with her brother.     

Intraspinal astrocytoma in a 3-year-old girl

A 3-year old patient with a spinal cord astrocytoma is presented. The clinical signs, diagnosis, neurosurgical, morphological results and prognosis are discussed. If there is any suspicion of an intraspinal abnormity, short-term neurological controls, somato-sensory evoked potentials and MRT of the spinal cord should be performed.     

Traumatic hip dislocation in a 3-year-old girl

Traumatic hip dislocation in the pediatric patient requires much less energy than in an adult, yet it remains a rare diagnosis. We report the case of a 3-year-old girl who dislocated her right hip when bindings failed to release as she skied downhill. The hip was promptly reduced in the nearest trauma center, and at 18 months after injury, there is no evidence of avascular necrosis. The potential risk of avascular necrosis is significant, and the risk rises greatly when reduction is delayed beyond 6 hours. Reduction can be safely performed in the emergency department, although up to 25% of cases will require open reduction in the operating room. A high index of suspicion is warranted to not miss the "golden window" and achieve satisfactory reduction in a timely fashion.     

Tricotillomania as an ictal manifestation of partial seizure in a 4-year-old girl

Indian Journal of Pediatrics -