Solid cystic pseudopapillary tumor of the pancreas in children: A case series

Solid cystic pseudopapillary tumor (SCPT) of the pancreas is rare and is difficult to diagnose pre-operatively. We describe four children with abdominal pain and abdominal mass who were diagnosed with SCPT. Three underwent resection of the mass, one an open liver biopsy. Histopathology showed solid epithelioid cells, cystic areas, and pseudopapillary structures. SCPT is a low-grade malignant tumor with good prognosis and should be suspected in any child with an abdominal mass and abdominal pain.Key Words: Solid cystic pseudopapillary tumor, pancreas

Relationship of serum vitamin D with liver disease severity and bone abnormalities in cholestatic children

@#<p style="text-align: justify;"><strong>Background:</strong> Vitamin D deficiency occurs in 10% to 36% of children with cholestasis. The relationship between serum vitamin D levels, severity of liver disease and bone abnormalities in children has not been extensively investigated.</p><p style="text-align: justify;"><strong>Objective:</strong> To determine serum vitamin D levels and its association with liver disease severity and presence of radiographic rickets in children with cholestasis.</p><p style="text-align: justify;"><strong>Methods:</strong> Children aged 0-10 years with cholestasis underwent serum 25-hydroxyvitamin D levels (25-[OH]D) determination, radiographs of wrists and knees and liver function tests. Liver disease severity was evaluated using the Child-Pugh score. Radiographs were assessed using Thacher Rickets Severity Score. Data were analyzed using odds ratio and Spearman's correlation coefficient.</p><p style="text-align: justify;"><strong>Results:</strong> We included 51 children [Mean (SD) age: 5 (6) months, 63% are males], mostly with biliary atresia (51%). Forty-seven (92%) had serum 25-(OH)D deficiency and four (8%) had insufficiency. Radiologic bone abnormalities were observed in 22 (43%) cases; specifically, rickets in 16 (31%). No association was observed with vitamin D levels and liver disease severity (OR 1.27, 95% CI 0.12-13.31) nor with rickets score (OR 0.07, 95% CI 0.004-1.37).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Majority of the children with cholestasis had vitamin D deficiency, with a third having radiographic findings of rickets. Serum vitamin D levels were not associated with liver disease severity or with rickets score.</p><p style="text-align: justify;"><strong>Key Words:</strong> Vitamin D, rickets, cholestasis, bone disease, bone abnormalities</p>

Features and Outcome of Hepatobiliary Tuberculosis among Filipino Children: Report of a Six-year Experience

Background@#The features and outcome of hepatobiliary tuberculosis (HBTB) have not been extensively reported in children.@*Objective@#To describe the clinical, biochemical, radiologic, microbiologic and histologic features and outcome of children diagnosed with HBTB. @*Methods@#Data of HBTB patients aged 0-18 years were collected by review of medical records and as they were admitted. Cases were classified as bacteriologically-confirmed (positive AFB smear, TB culture or PCR of bile/liver tissue) or clinically-diagnosed (clinical, histologic and/or radiologic evidence). @*Results@#A total of 36 patients were included (mean age: 13yrs; 64% males): three bacteriologically-confirmed and 33 clinically-diagnosed. Most common signs/symptoms were weight loss (69%), fever (67%), hepatomegaly (61%) and jaundice (53%). Of the total, 68% had hypoalbuminemia, 50% increased transaminases and 47% prolonged prothrombin time. Fifteen (42%) patients were AFB positive on various microbiologic specimens. Most common imaging finding was hepatic calcification (64%). Of 11 patients with liver biopsy, seven (64%) had chronic/ granulomatous inflammation. All 36 were managed medically. Eight were lost to follow up, six died, and 22 (61%) are alive, nine with complete resolution of liver disease. @*Conclusion@#Hepatobiliary tuberculosis presents with non-specific clinical and biochemical findings. Several investigations are necessary to confirm the diagnosis. Overall response to anti-TB treatment is satisfactory with possible resolution of liver disease.