Circumumbilical pyloromyotomy: larger pyloric tumours need an extended incision.

Circumumbilical pyloromyotomy has been used widely to offer an optimum cosmetic approach. On occasion, there are difficulties in delivering the large pyloric tumour through a relatively small incision. The authors prospectively collected a series of 39 consecutive pyloromyotomies performed over a period of 3 years in three teaching hospitals. Patients were aged 13 to 90 days (average 35) and the male-female ratio was 5:1. The initial operative approach was a right upper quadrant (RUQ) incision (n = 6) and later a circumumbilical incision (CUI), with or without lateral extension, combined with transverse division of the linea alba and part of both rectus muscles (n = 33). Two infants (1 RUQ and 1 CUI) developed wound infections, which were treated with antibiotics. There were no other peri- or postoperative complications. It was necessary to extend the incision in one-third of CUI cases (n = 12) in order to facilitate the delivery of a large pyloric tumour through the incision. Both omega-shaped (n = 3) and a new modified extension (n = 9) have been used with good cosmetic results.

Fine needle aspiration cytology of mesenchymal hamartoma of the liver. A case report.

BACKGROUND: Mesenchymal hamartoma (MH) of the liver constitutes the third or fourth most common tumor of the liver in childhood and occurs most commonly in the first two years of life. MHs of the liver are seldom aspirated, and reports on the role of fine needle aspiration (FNA) in the diagnosis of MH are scarce. Clinically, cytologically and even histologically, MH can be mistaken for a number of reactive and neoplastic hepatic lesions that may occur in children under 2 years of age. CASE: A 10-month-old Pakistani female presented with a history of a right-sided, nonpainful abdominal swelling. Abdominal computed tomography showed a large, partly solid and partly cystic, heterogeneous hepatic mass. FNA cytology showed clusters of both epithelial and mesenchymal/spindle-shaped cells with pieces of loose connective tissue. A cytologic differential diagnosis of mesenchymal hepatic hamartoma and hepatoblastoma of the possible mixed mesenchymal/epithelial subtype was rendered. The histopathologic diagnosis of the resected tumor mass was benign mesenchymal hamartoma of the liver. CONCLUSION: In children under 2 years of age who present with partly solid and partly cystic hepatic masses, the possibility of MH of the liver should be considered. FNA has a role in the diagnosis of MH. The cytopathologist should be aware of the patient's age, radiologic features and cytologic appearances of this rare, benign neoplasm. Histologic examination of tru-cut biopsies and immunohistochemical stains can help to exclude other pediatric neoplasms that may show cytologic features similar to or mimicking those of MH.

Transverse testicular ectopia: report of three cases.

Two patients who presented with a history of right inguinal hernia and a third with an impalpable left testis were found to have transverse testicular ectopia. Both testes were fixed in their own scrotum, through a modified Ombredanne operation in two patients and a subdartos pouch in one.

Ten years' experience in the management of cervical teratomas.

Five patients with cervical teratoma were seen between 1982 and 1992 in the Maternity and Children's Hospital, Riyadh, Saudi Arabia. All presented with a cervical mass at birth. Their weights ranged between 2.6 and 3.5 kg (average 3.1 kg); all were full-term babies, three girls and two boys. Three cases were diagnosed antenatally; three had a history of maternal hydramnios; three presented with severe respiratory distress at birth and needed endotracheal intubation. All patients underwent surgical treatment except one who died before surgical intervention because of severe respiratory distress. Surgery included complete resection of the tumor. The postoperative courses were uneventful. The histopathology of the tumor showed tissue from all three germ layers. Over 3-11 years of follow-up, none of the patients showed signs of recurrence. Postoperative thyroid function tests and serum alpha-fetoprotein showed no abnormalities. We conclude that antenatal diagnosis help to reduce the morbidity and mortality due to upper airway obstruction. Surgery is safe and represents the only way of treating this tumor.