Gynecomastia in a Filipino adolescent male: A rare forewarning sign of fibrolamellar hepatocellular carcinoma

@#We present a 15-year-old male with a two-year history of gynecomastia and a four-month history of gradually enlarging abdomen and right flank pain. Examination revealed severe stunting with breast mass Tanner Stage 3, penile stage 2, and hepatosplenomegaly. Laboratory investigations showed normal blood counts, liver function tests, alpha-fetoprotein, and beta-human chorionic gonadotropin. The imaging findings demonstrated multiple confluent masses in the liver, histologically diagnosed as fibrolamellar hepatocellular carcinoma.

Pediatric hepatic abscess: A ten-year review of the features and outcome at the Philippine General Hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> Hepatic abscess is a rare childhood infection with incidence of 1 to 140 per 105 admissions. It has signs and symptoms that mimic other liver diseases. This study determined the clinical, biochemical, microbiologic and imaging features and outcome of children diagnosed with hepatic abscess at a tertiary hospital in Manila.</p><p style="text-align: justify;"><strong>Method.</strong> We conducted a review of medical records of admitted patients aged ?18 years diagnosed with hepatic abscess in a tertiary referral center from 2007-2018. A diagnosis was confirmed if with (1) fever; (2) imaging study of solitary or multiple hepatic focus; AND (3) at least one more sign or symptom. We computed for mean (SD) for continuous variables or n (%) for categorical variables.</p><p style="text-align: justify;"><strong>Result.</strong> We included 40 patients out of 559, 583 pediatric admissions during the study period (0.007%), with a mean age of 8 years (SD 6.5), and 57% of whom were males. Thirty-seven (92%) were probable pyogenic in etiology, while three were tuberculous abscess. The most common signs and symptoms were fever (100%), abdominal mass (31%), abdominal distension (34%) and weight loss (31%). Majority had anemia (63%) and leukocytosis (89%). The most common imaging finding was a solitary mass (58%) with right lobe (80%) involvement. Nine abscess aspirates yielded Staphylococcus aureus (3), Mycobacterium tuberculosis (3), Klebsiella pneumoniae (1) and no growth (2). All patients were medically treated but eight also required percutaneous/surgical drainage. Majority (36) were discharged improved; four were improving but left before treatment completion.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Majority had pyogenic hepatic abscess, presenting with non-specific clinical and laboratory features. Most abscess were solitary and involved the right lobe. Limited abscess aspirates yielded Staphylococcus aureus and Mycobacterium tuberculosis. Prognosis is favorable with treatment.</p>