An unusual thyroid tumor in a child

Malignant neoplasms of the thyroid gland are quite rare in children. Winship, in his classic article, could find only 562 cases in the literature. The histopathological patterns resemble those of the adult tumors. Despite early cervical metastasis, the prognosis in general is favorable, with many long-term survivals. Prior exposure to radiation of the head and neck is a definite pre-disposing factor. Teratomas of the neck are a medical curiosity--less than 100 cases are described in the literature. The vast majority of these are found during the neonatal period, and are benign histologically. These are usually large, cystic, bulky masses which produce mechanical obstruction of the upper airway and digestive tract. Only one of these tumors, described by Pupovac in 1896, has been considered malignant. A six-year-old child was examined with a right thyroid mass of three months' duration. The thyroid scan showed a "cold nodule." At surgery, a well-encapsulated mass was found. The pathology showed a predominance of malignant spindle cells, with areas of papillary carcinoma; however, there were well-defined mucous glands present in the tumor. Clinically the child has remained well and asymptomatic. The slides have been extensively reviewed. To my knowledge no such tumor has been previously described. The tumor is considered to be a malignant thyroid tumor growing out of teratomatous tissue.     

Inflammatory myofibroblastic tumor in children

The authors presented the cases of two children with inflammatory myofibroblastic (IMF) tumor and reviewed the literature to facilitate the preoperative recognition, delineate the clinical features, and describe the natural history of this entity. The first child had IMF tumor arising from the mesentery of the small intestine. He presented with an abdominal mass associated with severe inflammatory response manifested by fever, impaired growth, thrombocytosis, and microcytic, hypochromic anemia. After surgical resection, his fever resolved and his growth rate and the laboratory abnormalities normalized. Five months after initial diagnosis, the fever, anemia, and thrombocytosis recurred along with two tumors arising from the omentum and the abdominal soft tissue. After the second surgery, he remains free of recurrent disease for 30 months. The second child presented with a lung mass that was radiologically indistinguishable from pulmonary sequestration. After surgical resection, she remains free of recurrent disease for 18 months. IMF tumor should be considered in any solid tumor that occurs in association with a chronic inflammatory response. IMF tumor should also be considered in the differential diagnosis of pulmonary sequestration.     

Inflammatory pseudotumors of the lung

Two unusual cases of inflammatory pseudotumors in young female patients are described. One presented with massive hemoptysis and a solitary circumscribed mass treated with urgent lobectomy. The second presented initially with cough and a small right lower lobe mass. She presented again, 8 years later, with a lung mass so expanded as to necessitate a pneumonectomy with partial resection of surrounding structures. Both cases indicate the need for early and complete removal of the inflammatory pseudotumors.     

Aortic valve tumor causing acute myocardial infarction in a child

A 10-year-old child presented with biventricular failure after an acute myocardial infarction. On investigation a large tumor arising from the aortic valve was diagnosed. The patient underwent successful aortic valve replacement for complete excision of the tumor mass, which was reported to be a papillary fibroelastoma. This case report highlights the unusual presentation of an aortic valve tumor in a child with myocardial infarction. The surgical dilemmas of the timing of the operation and the nature of the operation are discussed.     

The use of transbronchial lung biopsy to establish a diagnosis of benign clear cell tumor of the lung: report of a case

Benign clear cell tumor (BCCT) is an extremely rare pulmonary neoplasm. We report herein a case of BCCT of the lung that was diagnosed by a transbronchial lung biopsy (TBLB). The findings of hematoxylin-eosin and immunohistochemistry obtained by the TBLB were consistent with a diagnosis of BCCT of the lung. Wedge resection was subsequently performed by video-assisted thoracotomy. To the best of our knowledge, this is the first reported case of BCCT diagnosed by TBLB.     

Inflammatory pseudotumour of the trachea: report of a case in an eight-year-old child

A polypoid inflammatory pseudotumour was diagnosed in the trachea of an eight-year-old child who presented with asthmatic symptoms. The tumour showed 80 per cent blockage of the lower trachea and consisted of proliferating spindly fibroblastic cells admixed with a variable number of inflammatory cells. The literature on childhood inflammatory pseudotumours is reviewed together with the differential diagnosis of other polypoid mesenchymal tumours of the trachea.     

Sestamibi uptake in brown tumor simulating a lung mass

BACKGROUND: Anterolateral knee cysts are not uncommon in the first 7 years of life, but have not been described in the literature. METHODS: Four patients presenting with an asymptomatic lump on the anterolateral joint line were reviewed. RESULTS: The lump remains asymptomatic. CONCLUSIONS: Anterolateral knee cysts of childhood are benign and do not require treatment. Their cause is conjectural.     

Prenatal diagnosis of a fetal intracranial tumor

Cap polyposis is a rare intestinal disease that can be difficult to differentiate from inflammatory bowel disease. When cap polyposis is suspected, it is important to confirm protein loss. A 54-year-old woman who had been treated for ulcerative colitis for 7 years had severe hypoproteinemia. Scintigraphy with Tc-99m-labeled DTPA complexed with human serum albumin showed protein loss from the descending colon. Left hemicolectomy and sigmoid colectomy were performed. Cap polyposis was diagnosed on the basis of histologic findings from an operative specimen. The patient's diarrhea resolved after surgery and her hypoproteinemia improved. Scintigraphy with this label gave information helpful in the diagnosis of cap polyposis.     

Histopathology: its role in the diagnosis of a child with intussusception

Spontaneous expulsion of a small portion of the intestinal mucosa per rectum, in an infant, associated with ileocolic intussusception is an extremely rare condition. This appears to be the first report of such a clinical presentation. The initial diagnosis was raised by the histopathologist following examination of the eliminated piece of tissue. Subsequent barium enema and laparotomy confirmed the diagnosis and the ileocolic intussusception was successfully reduced. This unusual presentation, together with a review of the pertinent literature, is discussed. Our findings indicate that both the clinicians and histopathologists should be aware of this phenomenon and stress the importance of the histological examination of any unusual faecal matter. This may prove to be a simple, quick and cheap method of investigation of this condition.     

Mediastinal germ cell tumor in a child with precocious puberty and Klinefelter syndrome

An 8-year-old boy presented with precocious puberty and a mediastinal mass. A computer search showed that this rare presentation is most common with germ cell tumor of the mediastinum in children with Klinefelter syndrome. The tumor was completely resected after preoperative chemotherapy, and the patient is well 2 years after the operation. In patients with Klinefelter syndrome, germ cell tumors are 50 times more common than in patients without Klinefelter syndrome, usually contain nonseminomatous elements, present at an earlier age, and are seldom testicular in location.     

Surgery for thoracic empyema concurrent with rupture of lung abscesses in a child

The authors report surgical treatment for thoracic empyema concurrent with rupture of lung abscesses and completely collapsed lung in a child. Right middle lobectomy for ruptured abscess, debridement and closure with interrupted sutures for another abscess in the lower lobe, and decortication were performed. Positive-pressure ventilation was needed to prevent reexpansion pulmonary edema because of long-term collapsed lobes. The patient is doing well with no recurrent empyema or thoracic deformity at 3 years postoperation.     

Inflammatory pseudotumor of the lung in hilus lymph node histoplasmosis

The article deals with the case of an inflammatory pseudotumour of the lung in conjunction with histoplasmosis of the hilar lymph glands in a 35-year-old immunocompetent woman in a non-endemic area. She had been suffering from headaches and painful swelling of the lower legs, reddening and hyperthermia for 1.5 years. In addition to the above-mentioned symptoms she also complained of a typical flush syndrome which had begun a year later. The main paraclinical finding was a round mass in the right lung in chest radiography. After considering various differential diagnostic possibilities, thoracotomy and resection of the upper lobe of the right lung were performed. The histological diagnosis of the material removed was that of an inflammatory pseudotumour of the lung, combined with histoplasmosis of the hilar lymph glands. Following a postoperative period without complications, antimycotic treatment was performed. The discussion includes whether the simultaneous occurrence of these two diseases is coincidental or whether there is a causal relation between the two. The authors also discuss various treatments with reference to the relevant literature.     

Radioisotope diagnosis in lung diseases]

Following immunization against sheep erythrozytes, it is possible to induce a double-peaked antibody response curve in the serum of experimental animals (rats) by using vincristine sulfate (Vi). Immunosuppression is enhanced in thymectomised and sensitised animals during rechallenge following Vi/Cy, as compared to animals treated with cyclophosphamide (Cy) alone, and an attentuated anamnestic reaction is subsequently observed. Survival time of allogeneic skin grafts in colony bred and inbred rat strains could not be prolonged by using Vi/Cy, as compared to animals treated with Cy alone.