Testicular Teratomas In Children- Case Series

Testicular tumors are very uncommon in children and teratomas are the commonest of these tumors. We are reporting our experience with five cases of testicular teratomas in the last 25 years.

Fetus-in-fetu presenting as acute intestinal obstruction.

Fetus-in-fetu is a rare condition in which a fetiform calcified mass is often present in the abdomen of its host; a newborn or infant. We present the case of a three-month-old male baby with acute intestinal obstruction and abdominal mass. X-ray abdomen and ultrasonogram revealed a cystic mass with calcification. On laparotomy, a well encapsulated retroperitoneal mass causing high intestinal obstruction was identified. Total excision of the mass was done. Diagnosis of fetus-in-fetu was confirmed on histopathology. Postoperative recovery was uneventful.

Non-familial paediatric colorectal cancers - an 18 years’ experience.

Background: Primary gastrointestinal malignancies constitute only 1% of all paediatric neoplasms. Aim: The aim of this study was to describe our 18 years’ experience with non-familial paediatric colorectal malignancies, outlining pertinent features of diagnosis, treatment and outcome. Methods: 9 patients of non-familial paediatric colorectal malignancies were admitted in PGIMS, Rohtak, Haryana between 1990 and 2008. After the initial surgical management, the advanced cases underwent chemotherapy and radiation therapy where required and were followed up. Results: There were six male and three female patients (age range: 7 to 16 years). Three tumours arose in the rectum, three in the sigmoid colon, one each in the splenic flexure and appendix, and there was one case of diffuse colonic polyposis. All cases presented with obstruction and rectal bleeding. Two cases of sigmoid carcinoma were unresectable and expired 4 months post-surgery. The rest responded to radical resection. Three patients required palliative radiation therapy. Due to the advanced stage, chemotherapy was given to all the carcinoma patients. One patient had local recurrence after 5 months and another developed distant metastasis. The rest are on follow-up and clinically and radiologically disease free. Conclusion: Paediatric colorectal malignancy is a rare entity, usually diagnosed in the later stages, culminating in advanced disease. A majority of cases undergo radical resection due to the advanced stage of presentation. Advanced stages may also require chemotherapy and radiation therapy.

Omphalomesenteric duct cyst as a content of omphalocele.

A rare occurrence of an omphalomesenteric duct cyst in an exomphalos minor sac is reported herein. The noteworthy points in this case were an unusual presentation of the rarest variety of umbilical cord cyst. The tapering intra-abdominal end of the cyst was found to be attached to the ileal mesentry, thereby simulating a herniating mesenteric cyst till the histolopathological report resolved the issue.

Traumatic diaphragmatic herniation.

Traumatic diaphragmatic hernia is rare in children. Left-sided Herniations are seen in 90%. The diagnosis is often delayed for months to years because of its rarity and overshadowing injuries. Chest/abdominal radiographs and, in particular cases, computed tomography and ultrasound improve the accuracy of diagnosis. We report two cases of traumatic diaphragmatic rupture in children. The history of trauma along with plain X-rays/barium study was diagnostic in both the cases.

Associated anomalies with anorectal malformation (ARM).

OBJECTIVE: To find the prevalence of associated anomalies in children with anorectal malformation (ARM). METHODS: One hundred and forty patients (80 males and 60 females) with expand were studied to detect associated anomalies and to find their prevalence. High and low type of ARM was seen in 52.14% and 47.86% of patients respectively. Associated anomalies were more common with high type of ARM (78.08%) than in patients with low type of ARM (37.31%). 58.57% patients had associated anomalies which included those of urinary system (37.14%), vertebral system (34.28%), skeletal system other than vertebral (15.17%), genital system (14.29%), cardiovascular system (12.14%), gastrointestinal tract (10.7%) and spinal cord (10%). RESULTS: 37.43% patients had 3 or more than 3 components of VACTERL association. Two patients had all six components of VACTERL. Most common association was vertebral, anal and renal anomalies seen in 16 patients. CONCLUSION: Patients with ARM should undergo a detailed general physical, systemic and radiological examination (infanto-gram, echocardiography, US of urogenital system) in neonatal period to detect associated anomalies in early period.

Mesoblastic nephroma of infancy.

This report presents features of mesoblastic nephroma, a rare benign tumor of kidney observed in perinatal period of life and highlights the role of imaging investigations in the proper management of this tumor. Awareness of this tumor may facilitate prevention and management of severe obstetric and neonatal complications and inadvertent and vigorous therapy compatible with that of Wilms' tumor can be avoided.

Mediastinal foregut duplication cysts.

Foregut duplication cysts are rare congenital anomalies of enteric origin. In majority of the patients, the diagnosis is made in infancy. The authors report 4 cases of mediastinal foregut duplication cyst in children diagnosed on CT/MRI and confirmed on histopathology. In none of the cases the cysts had intraspinal extension nor heterotopic gastric mucosa.

Imaging in acute abdomen.

OBJECTIVE: The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen. METHODS: Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 3 1/2 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively. RESULTS: There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel's diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions. CONCLUSION: US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis.