Laparoscopic gastric diverticulectomy in a 13-year-old girl

Symptomatic gastric diverticula are rare, mainly occurring in patients between 20 and 60 years of age. In adults, laparoscopic resection seems to be an attractive alternative to conventional surgery, although some authors experienced problems in identifying the diverticulum intraoperatively. We present a case of a gastric diverticulum in a 13-year-old girl and emphasize the difficulties in establishing the diagnosis. Once other gastrointestinal disorders were excluded, a laparoscopy was performed and the diverticulum resected successfully with an endoscopic linear stapler device. This is the first report on laparoscopic resection of a gastric diverticulum in a child. More experience is mandatory to confirm the safety and long-term success of a minimal invasive technique for this pathologic entity in pediatric patients.     

Giant omental lipoma in a 13-year-old adolescent girl

Although lipoma is a common benign mesenchymal tumor, its occurrence in the omentum is a rare finding. We report an unusual case of omental lipoma in a 13-year-old adolescent girl. The mass was completely excised and weighed 12.3 kg. The patient is alive and well with no evidence of recurrence at 4 months of follow-up.     

Torsion of fallopian tube in a 13-year-old unmarried girl

A 13-year-old unmarried female presented with severe colicky lower abdominal pain, radiating to left side, not associated with fever. Ultrasound examination showed a dilated left fallopian tube with minimal free fluid in pelvis, and diagnosis of pelvic inflammatory disease was suggested. MRI of the pelvis showed a complex intensity mass in left adnexa, suggesting a germ cell tumour. Patient underwent diagnostic laparoscopy and laparoscopic removal of left fallopian tube. Histopathology finally established the diagnosis of left fallopian tube torsion.     

Implantation metastasis in a 13-year-old girl: a case report

We report a case of a 13-year-old girl with an osteosarcoma of the right humerus, which had been diagnosed as an aneurysmal bone cyst at our institution. She underwent curettage and bone grafting of the lesion, which resulted in implantation metastasis of the tumour to the ilium. She died 15 months after presentation owing to pulmonary metastases. This report highlights the possibility of metastasis occurring by direct implantation to a graft donor site. We strongly recommend that a biopsy be performed in cases of presumed benign lesions before proceeding with the definitive surgery.     

Gingival swelling in a 13-year-old girl with multiple recurrences.

We present a challenging case of gingival swelling that recurred several times in 3.5 years in a 13-year-old girl. Histologic evaluation of the initial biopsy revealed groups of epithelioid cells surrounded by lymphocytes in the submucosal fibrous connective tissue, and it was diagnosed as noncaseating granulomatous inflammation. With the tissue specimens from subsequent multiple excisions and several immunohistochemical studies, the diagnoses evolved to benign cellular infiltrate of undetermined origin, epithelioid hemangioma, proliferating endothelial cell neoplasm of uncertain biologic potential, atypical vascular tumor, epithelioid hemangioendothelioma, and kaposiform hemangioendothelioma. We discuss the list of differential diagnoses from various pathologists and propose our diagnosis of epithelioid hemangioendothelioma based on its clinical behavior, histologic features, and immunohistochemical findings.     

Nephropathy associated with Wilms' tumor. A case of a 13-year-old girl

The association of nephropathy with Wilms' tumor and male pseudohermaphroditism is known as Drash's syndrome. The absence of either pseudohermaphroditism or Wilms' tumor has also been reported. The nephropathy, characterized by proteinuria or nephrotic syndrome, leads rapidly and inevitably to renal failure. The renal findings are those of a chronic glomerulopathy with mesangial hypercellularity, glomerular sclerosis, interstitial infiltration and marked tubular dilation. This infrequent syndrome usually appears in early life, between 1 and 3 years of age. The case of nephropathy associated with Wilms' tumor we present here is characterized by age and onset: an abrupt onset of renal insufficiency without previous signs of nephropathy in a 13-year-old girl.