Giant cystic abdominal masses in children

In this pictorial essay the common and uncommon causes of large cystic and cyst-like abdominal masses in children are reviewed. We discuss and illustrate the following: mesenchymal hamartoma, choledochal cyst, hydrops of the gallbladder, congenital splenic cyst, pancreatic pseudocyst, pancreatic cystadenoma, hydronephrosis, multicystic dysplastic kidney, multilocular cystic nephroma, adrenal hemorrhage, mesenteric and omental cysts, gastrointestinal duplication cyst, meconium pseudocyst, ovarian cysts and cystic neoplasms, hematocolpos, urachal cysts, appendiceal abscess, abdominal and sacrococcygeal teratoma, and CSF pseudocyst. We also describe imaging features and clues to the diagnosis.     

Neonatal spontaneous colonic perforation due to cystic fibrosis

We report two cases of spontaneous colonic perforation associated with cystic fibrosis (CF) in the neonatal period. Both presented with an acute abdomen soon after birth and required laparotomy and stoma formation. Colonic perforation as an initial presentation of CF is reviewed and management options are discussed.     

小儿腹腔及腹膜后囊性肿物腹腔镜治疗11例

目的:探讨腹腔镜治疗小儿腹腔及腹膜后囊性肿物的可行性及疗效。方法:回顾性分析2015年6月至2019年1月福建医科大学附属泉州第一医院小儿外科收治的腹腔或腹膜后囊性肿物患儿11例,其中男6例,女5例;年龄8个月～10岁,平均59个月。患儿囊性肿物9例来源于腹腔,2例来源于腹膜后,均于腹腔镜下行肿物切除术。结果:11例患...     

新生儿腹腔囊性肿块108例病理与临床结果

目的分析新生儿期腹腔囊性肿块患儿的病因、病理、预后及转归。方法收集2008年8月至2013年7月我院新生儿外科术前诊断腹腔囊性肿块的病例,分析其性别、入院日龄、病因、治疗效果、病理及随访,总结预后及转归。结果 108例患儿中男女比例为40∶68;入院日龄3 h至28天,平均12天;住院日8～23天,平均11.2天;105例为足月儿,3例为早产儿。产前检查发现腹腔肿块42例（36例择期剖宫产）,新生儿期发现66例（27例剖宫产分娩）。91例患儿在新生儿期完成手术,15例患儿在生后1～3个月实施手术,均痊愈出院,另2例未行手术治疗。术后病理证实：胆总管囊肿51例,卵巢囊肿25例,肠源性囊肿16例,肠系膜淋巴管瘤6例,其他8例。2例开腹胆总管囊肿根治术患儿术后因粘连性肠梗阻再次行肠粘连松解术,恢复良好,其余手术患儿均健康成长。结论新生儿腹腔囊性肿块以女性稍多见,胆总管囊肿和卵巢囊肿占大部分,肠源性囊肿和肠系膜淋巴管瘤也是常见原因。新生儿腹腔囊性肿块患儿绝大多数预后良好,转归满意。     

Solitary osteochondroma: spontaneous regression

Osteochondromas are the most common benign bone tumours. Nevertheless, their origin and biological behaviour are poorly understood. Rarely, spontaneous regression of osteochondromas may occur. We report the case of a 9-year-old girl with a solitary osteochondroma of the femur that regressed almost completely within 4 years, a fact that should be taken into account when deciding the management of these lesions, especially in young children.     

Post-traumatic pancreatic pseudocyst with spontaneous regression

A 9 year old boy presented a pancreatic pseudocyst in the early course of a traumatic pancreatitis (10th day after an abdominal trauma). The child remaining asymptomatic, a simple echographic and biological supervision (amylasemia and amylasuria) was adopted. Amylasemia and amylasuria were normalized within one month. Repeated echographies showed an increase of the size of the cyst at first, followed by its regression and disappearance within 2 months.     

Multicentric infantile myofibromatosis with spontaneous regression

We report a patient with multicentric infantile myofibromatosis who showed remarkable regression of the lesions. This 7-month-old male was admitted for evaluation of generalized subcutaneous tumor nodules. A radiographic bone survey revealed radiolucent lytic areas in the skull, axis, rib, humerus, femur, ilium, and tibia that resembled a primary neoplasm with multiple metastases. An exisional biopsy, however, led to a diagnosis of infantile myofibromatosis. All the subcutaneous nodules regressed spontaneously within 1 year and 9 months. Correspondence to: Y. Yamaguchi     

Significance of residual abdominal masses in children with abdominal Burkitt's lymphoma

Purpose: To evaluate the natural history of children with abdominal Burkitt's lymphoma who had complete clinical remission and residual abdominal mass after treatment. Material and methods: The charts and imaging findings of all children with abdominal Burkitt's lymphoma treated and followed at our medical center between 1988 and 1999 were reviewed for the presence, management, clinical course, and prognosis of residual mass. Results: Only children who achieved complete clinical remission were included. The study group consisted of 33 children (20 boys and 13 girls) aged 2.6–17.6 years (mean 7.2 years). Of these, seven (20.6 %) were found to have a residual abdominal mass. Two underwent second-look operation with no evidence of viable tumor on histology. The remaining five were followed by imaging studies for 2.2–9.1 years (mean 6.1 years); none relapsed. Conclusion: Residual mass is not uncommon in children with abdominal Burkitt's lymphoma. The presence of residual mass in a child with complete clinical remission does not alter the long-term prognosis. Therefore, in children with Burkitt's lymphoma and residual mass with no other signs of disease activity, expectant watching may be appropriate. Received: 10 December 2000 Accepted: 25 June 2001     

Neonatal colonic atresia: ultrasound findings

High resolution real-time ultrasound examination of the abdomen was performed in a neonate with abdominal distention. Dilated distal small bowel and a complex mass in the course of the ascending colon were noted. Ultrasound correctly suggested the diagnosis of mid-colonic atresia with a patent ascending colon twelve hours prior to the radiographic demonstration of gas in the obstructed right colon. The sonogram was also able to accurately exclude the presence of ascites or a renal or hepatic mass as the cause for abdominal distention.     

Neonatal screening for cystic fibrosis: present and future

Despite there being effective tests for detecting cystic fibrosis (CF) using newborn screening blood samples, screening in neonates has not had universal approval because of uncertainty about its benefits. After up to 18 y experience, at a recent conference in Caen several aspects attracted universal agreement. There is still major delay in clinical diagnosis after the onset of symptoms. There is short-term benefit in early diagnosis by screening, with reduced morbidity in the first 2 y, evidence of significant nutritional benefits up to the age of 10 y, and probable respiratory benefit over this time frame. There is great potential for research into treatment modalities and no evidence of significant psychological harm to CF babies from early diagnosis. With a screening protocol that includes a DNA test there is some unwanted carrier detection and careful genetic counselling is needed. There is no evidence yet that screening will extend the life of CF patients, so some doubts remain as to its overall effectiveness, and there have been no good studies on comparative costs in screened and unscreened cohorts. Even so, the weight of evidence suggests very worthwhile advantages for screened babies and their families. Because of this, it is unlikely that further trials will take place. It may be that the onus now is on those who do not support screening to justify this stance to parents who may favour it.     

Neonatal screening for cystic fibrosis: present and future

Despite there being effective tests for detecting cystic fibrosis (CF) using newborn screening blood samples, screening in neonates has not had universal approval because of uncertainty about its benefits. After up to 18 y experience, at a recent conference in Caen several aspects attracted universal agreement. There is still major delay in clinical diagnosis after the onset of symptoms. There is short-term benefit in early diagnosis by screening, with reduced morbidity in the first 2 y, evidence of significant nutritional benefits up to the age of 10 y, and probable respiratory benefit over this time frame. There is great potential for research into treatment modalities and no evidence of significant psychological harm to CF babies from early diagnosis. With a screening protocol that includes a DNA test there is some unwanted carrier detection and careful genetic counselling is needed. There is no evidence yet that screening will extend the life of CF patients, so some doubts remain as to its overall effectiveness, and there have been no good studies on comparative costs in screened and unscreened cohorts. Even so, the weight of evidence suggests very worthwhile advantages for screened babies and their families. Because of this, it is unlikely that further trials will take place. It may be that the onus now is on those who do not support screening to justify this stance to parents who may favour it.     

Cystic dysplasia of the testis: spontaneous regression

Cystic dysplasia of the testis is a rare disorder, characterized by irregular cystic spaces within the mediastinum or rete testis. Ipsilateral renal defects are seen in many patients with cystic dysplasia of the testis. Although cystic dysplasia of the testis is considered a benign lesion, it has typically been treated with orchiectomy. We report a child with cystic dysplasia of the testis in whom spontaneous regression of the US findings occurred. This suggests that conservative management, through regular observation with US, may be the more desirable initial course of treatment for patients with this disorder.     

Neonatal cranial ultrasound interpretation: a clinical audit

OBJECTIVE: To assess the abilities of doctors to interpret neonatal cranial ultrasound scans. DESIGN AND SETTING: High resolution scanned images of six important neonatal cranial ultrasound abnormalities were posted as a questionnaire to the 59 neonatal units in the North and South Thames regions. RESULTS: Forty two questionnaires were returned (71%). Currently 56% of those interpreting cranial ultrasound scans are neonatal registrars, 27% are consultant paediatricians or neonatologists, and 17% are radiologists. The response rate from registrars was excellent (97%), but it was poor from consultant paediatric (38%) and radiological (40%) staff. The mean accurate identification of cerebral abnormalities was only 59% (range 45-71%). Only 44% of the neonatal registrars, compared with nearly all the consultant staff, have had any formal training in cranial ultrasonography. CONCLUSIONS: The data highlight the current accuracy of neonatal cranial ultrasound scan reporting in the Greater London region and have important implications for clinical services and research studies. Doctors who are responsible for interpreting neonatal cranial ultrasound scans should have formal training and supervision, and more formal reporting would improve and maintain standards. The findings raise significant doubts about the accuracy of local interpretation of cranial ultrasound scans in multicentre research studies.     

Neonatal small left colon in an infant with cystic fibrosis

A small left colon has been observed in neonates due to several causes: aganglionosis, meconium plug, and neonatal small left colon syndrome. We report a case of small left colon in an infant with cystic fibrosis, underscoring the need to consider this disease in the diagnostic work up.