Leydig cell hyperplasia in children: Case series and review.

INTRODUCTION: Leydig cell hyperplasia (LCH) and Leydig cell tumours (LCTs) in children are rare, typically presenting with precocious puberty. Previously, orchidectomy was the routine management; however, more recently, testis-sparing surgery has been performed with good results. We present a series of unusual presentations of LCH, raising new management questions, and a review of the literature regarding LCH and LCT in children. STUDY DESIGN: We performed a literature search using Ovid Medline, PubMed, and Google Scholar, producing 456 articles. We reviewed all case reports and series containing paediatric patients, and relevant review articles. RESULTS: We report three cases of LCH, two of which were incidental findings. All three cases underwent testis-sparing surgery. In the literature there were seven cases of LCH and 101 cases of LCT in prepubertal children. The most common presentation was with precocious puberty. Three cases of LCH and more than two-thirds of LCTs were managed with orchidectomy and overall only 11% of the cases underwent testes-sparing surgery (24% did not specify operative management). There were no reports of recurrence or malignancy. DISCUSSION: Our case series presents three new clinical presentations of LCH that have not previously been reported in the literature: one of incomplete precocious puberty and two with incidental findings on ultrasound in asymptomatic children. Historically, children with the classic presentation of precocious puberty and a testicular lesion have been managed with orchidectomy. Nowadays, many clinicians advocate testes-sparing surgery given there have been no cases of malignancy. In children with no clinical or biochemical signs of precocious puberty, lesions identified on ultrasound can be safely monitored for a period of time. However, if the lesion does not regress, excisional biopsy is recommended to establish the diagnosis, ideally before the onset of puberty. CONCLUSION: Leydig cell hyperplasia and tumours in pre-pubertal children are benign. Testes-sparing surgery with regular follow-up appears to be safe management.

Testicular and paratesticular pathology in children: a 12-year histopathological review.

BACKGROUND: Our institution is the principal pediatric surgical referral center for a population of 1.6 million. The objective of this study was to determine the spectrum and incidence of pediatric testicular and paratesticular pathology in this population. METHODS: Pathology results of all testicular and paratesticular specimens between August 1995 to September 2007 were analyzed. Clinical details were retrieved retrospectively from the computerized database, recording age, mode of presentation, laterality, and associated inguinoscrotal pathology. RESULTS: Over 12 years 2 months, 474 patients (502 specimens) were identified. Testicular and paratesticular pathology was most frequent in patients aged 1-2 years (11%) and 11-12 years (10.5%). In all, 442 patients had non-neoplastic pathology, with 60.4% presenting acutely. The most common non-neoplastic pathologies were hydatid of Morgagni (42.6%) and "vanishing testis" (14.3%). Vanishing and atrophic testes were frequently explored between 1 and 2 years of age, with a left predominance. Most atrophic testes were undescended (54.8%). Testicular torsion occurred in 11.2%, with bimodal peak ages of <1 year and 13-14 years. Interestingly, testicular torsion also occurred more on the left side (68%). A total of 32 patients had neoplasms. Of 27 patients with testicular neoplasms, 55.6% were malignant (29.6% primary and 26% secondary), the principal primary malignancy was yolk sac tumor; the most common benign neoplasms were epidermoid cysts and teratomas. Five patients had paratesticular neoplasms, with rhabdomyosarcoma in 80%. CONCLUSIONS: The variety of scrotal and testicular pathology in children is considerable, with acute pathologic conditions comprising the bulk in the older (7-15 years) children, whereas impalpable testes and neoplasms comprise most of the lesions in infants. Interestingly testicular torsion, vanishing testes, and atrophic testes occur mainly on the left side. Benign testicular neoplasms occur more frequently than primary malignancies.

Reduction labioplasty in adolescents.

PURPOSE: To look at the presentation and management of labial hypertrophy in 2 young adolescents. TYPE OF STUDY: Case report MAIN FINDINGS: We present two cases, a 10-year-old girl with concerns regarding a hypertrophied labia minora and a 12-year-old girl with spina bifida and difficulty in performing intermittent catheterization because of the hypertrophied labia. We discuss a simple technique for reduction labioplasty and the different surgical options. CONCLUSION: Hypertrophy of one or both labia minora can lead to functional, social, esthetic and sexual problems in females of all ages. As the age of sexual awareness and activity gets younger we can expect more presentations of this problem in the pediatric population. Many girls with spina bifida may also present with problems due to the hypertrophied labia. As pediatric surgeons are called upon to deal with adolescent gynecology we need to be competent in managing this condition.

Is contralateral exploration necessary in preterm infants with unilateral inguinal hernia?

PURPOSE: Contralateral inguinal exploration has been the preferred approach to preterm infants with unilateral inguinal hernia. There is no literature evidence to justify this. The aim of this prospective study is to analyze the incidence and to determine any risk factors for the development of contralateral metachronous hernia (MH) in the preterm when compared with term infants. METHODS: Preterm and term infants with unilateral inguinal hernia younger than 6 months who underwent surgery were included. Those infants who subsequently developed MH were analyzed. RESULTS: Two hundred sixty-six patients met the inclusion criteria. One hundred five were preterm and 161 were term. Ten preterm (10.31%) and 9 term infants (5.92%) presented subsequently with MH (P =.18). All but 1 were male. There was no relation between the side of hernia, presentation with incarceration, age at surgery, sex of the patient, and the development of MH. However, a trend toward a higher incidence of MH in very low birth weight and early gestational age preterms was noted. CONCLUSION: There is no significant difference between the occurrence of MH in preterm when compared with term infants. Routine contralateral exploration in preterm infants with its associated risks is therefore not justified in unilateral hernia.

Polycystic ovaries, precocious puberty and acquired hypothyroidism: The Van Wyk and Grumbach syndrome.

Long-standing acquired hypothyroidism can rarely be associated with precocious puberty and polycystic ovaries. The authors report such a case, which responded to the simple replacement of thyroid hormone. It is important to look for hypothyroidism in girls with ovarian masses and precocious puberty to avoid surgery on the ovaries.