Connective tissue nevi in children: institutional experience and review.

BACKGROUND: Connective tissue nevi (CTN) are circumscribed hamartomas of the skin in which there is an abnormal mixture of normal components of the dermis that may be sporadic or associated with syndromes such as Buschke-Ollendorff, tuberous sclerosis, and Proteus. OBJECTIVE: We sought to specify the clinical and histologic features of CTN in childhood and to propose a diagnostic approach and updated classification. METHODS: This was a retrospective study in a tertiary pediatric outpatient population, accessing clinical and histopathological records. RESULTS: We classified 114 cases of CTN from 1980 to 2008. LIMITATIONS: The majority of cases were confirmed by histopathological examination. Therefore, our series excludes many CTN that were not biopsied. In addition, follow-up was variable. CONCLUSION: Our series demonstrates the usefulness of a modified classification for CTN. Biopsy should be done when clinical diagnosis is uncertain, or in multiple lesions. When biopsy is performed it should include normal-appearing skin for comparison and, in Buschke-Ollendorff syndrome, limited anterior-posterior x-rays of the hands, wrists, feet, ankles, knees, and pelvis instead of a full skeletal survey.

Radiographs interpretation by forensic pathologists: a word of warning.

In child deaths investigation, radiologic examination is particularly important in the diagnosis of child abuse. In the province of Quebec, Canada, all autopsies for suspicious deaths are performed at a centralized forensic laboratory where, because of budget restrictions, forensic pathologists rely on their own knowledge for radiographs interpretations. To assess the validity of this radiologic examination by nonradiologist forensic specialist, we reviewed all cases of child death on a 1-year period. A total of 20 cases were reviewed by an experienced pediatric radiologist, and this interpretation was compared with pathologist's conclusions. Forensic pathologists missed an important finding in 3 positive cases. Yet, none of those missed findings would have significantly changed the cases outcome, because other autopsy findings had already oriented the final diagnosis. Nevertheless, this result is alarming. In a general context of financing problems, it can be appealing to management team to restrict access to external consultants. This study is important in reminding that such money savings do not come without a decrease in quality.

Herniation of a calcified cervical disc into the foramen transversarium in an 8-year-old child.

STUDY DESIGN: Herniation of a calcified C3-C4 disc into the left foramen transversarium in a child is reported. OBJECTIVE: To discuss the natural history and management of a calcified disc herniation into the foramen transversarium. SUMMARY OF BACKGROUND DATA: Cervical disc calcification in children usually follows a benign course. Herniation of the calcified disc into the spinal canal has already been described. However, herniation into the foramen transversarium has never been reported. METHODS: An 8-year-old girl presented with progressive neck pain and torticollis. Her neurologic examination was normal. She was treated using a head halter traction, analgesics, and muscle relaxants for 3 days, followed by the use of a soft cervical collar for 2 weeks. RESULTS: Computed tomography scan showed a calcified C3-C4 disc with herniation into the C3 left foramen transversarium. Her symptoms subsided and she rapidly regained full range of motion of her neck after 3 days of conservative treatment. Magnetic resonance angiography done after 2 months did not show any residual compression of the left vertebral artery. After 3 months, the herniation had completely disappeared, whereas only a small central calcification remained in the C3-C4 disc space. CONCLUSION: The natural history of cervical disc calcification is usually benign. A computed tomography scan can be performed for patients in whom a calcified disc herniation is suspected on the plain films. In this case of herniation into the foramen transversarium, magnetic resonance angiography was useful to evaluate the integrity of the vertebral arteries. Spontaneous resolution of the herniated disc and return to normal function can be expected with conservative treatment.