Masses In Childhood Research Articles

Visual Loss in Childhood

An eight-year-old girl presented with vision loss and optic atrophy. Neuro-imaging revealed a sellar mass, which when biopsied proved to be a chiasmatic/hypothalamic glioma. The differential diagnosis of a sellar mass in childhood is discussed, and the presentation and management of chiasmatic/hypothalamic gliomas is reviewed.

Randomly Diagnosed Intraabdominal Masses in Childhood

Randomly Diagnosed Intraabdominal Masses in Childhood

Vascular anomalies of the mediastinum.

Vascular anomalies, including hemangiomas and vascular malformations, comprise 3% to 6% of mediastinal masses in childhood. These lesions, whether in the mediastinum or elsewhere, often are misdiagnosed and treated inappropriately. Correct diagnosis almost always can be established by history, external physical examination of associated anomalies, bronchoscopy, and/or radiographic studies. Hemangiomas are benign tumors that involute spontaneously but may require antiangiogenic therapy or laser ablation to maintain airway patency prior to involution. Vascular malformations, most commonly lymphatic in origin, will not involute nor respond to drug therapy. Resection and/or sclerotherapy often are indicated.

Relative osteopenia after treatment for acute lymphoblastic leukemia.

Osteoporosis in adult life is associated with a significant morbidity and may be predisposed to by osteopenia and failure to reach peak bone mass in childhood. Children treated for acute lymphoblastic leukemia (ALL) may be at risk of osteopenia as a result of previous therapy or as a consequence of the disease process itself. Dual energy x-ray absorptiometry measurements of bone mineral content (BMC) for the whole body and at the lumbar spine and hip were taken in 35 (14 male) long-term survivors of ALL and compared with results in 20 (10 male) survivors of other malignancies and 31 (17 male) healthy sibling controls. The measured BMC was expressed as a percentage of a predicted value derived from the control group and based on the variables that had influence upon it. BMC (%) was reduced at the spine in the ALL group compared with controls [92.4 (8.0)% versus 100.4 (9.7)%, respectively; p < 0.005] and at the hip compared with both other malignancies and controls [89.0 (11.5)% versus 96.1 (11.7)% and 100.4 (9.2)%, respectively; p < 0.0005]. Increasing length of time off therapy was associated with a significant increase in %BMC at both the spine and the hip. For the spine, this association was significantly different between the ALL group and other malignancies, suggesting that any gain in %BMC after therapy was slower in children treated for ALL. Both exercise capacity and levels of physical activity were correlated with %BMC at the hip (r = 0.44, p < 0.001 and r = 0.29, p < 0.01, respectively). Previous exposure to methotrexate, ifosfamide, and bleomycin was associated with a reduction in %BMC at the spine. Exposure to 6-mercaptopurine and cisplatin was associated with a reduction at the hip. In conclusion, children treated for ALL are osteopenic. The mechanism is probably multifactorial but is partially related to previous chemotherapy, limited exercise capacity, and relative physical inactivity.

Dietary Calcium Consumption is Better Among Female High School Students who are Athletes

Gaining optimal bone mass in childhood, adolescence, and young adulthood is believed to be the best protection against bone loss and osteoporosis. Women in teen and early adult years need to consume more dietary calcium in order to build bone mass. In addition, weight bearing activity enhances bone mineralization which promotes and protects bone mass density. A thirty-three item Food Frequency Questionnaire (FFQ) was designed to estimate dietary calcium consumption habits. Foods included in the questionnaire included those commonly consumed by the teenage population. A typical portion size was listed to facilitate accurate estimations of the number of servings consumed. Incomplete surveys were not included in the data analysis. One hundred thirty-five females attending three suburban high schools in New Jersey were surveyed. Dietary and demographic data were complete for 67 athletes and 56 non-athletes. The respondents were predominately Caucasian (92% of the athletes and 86% of the non-athletes). Female athletes consumed significantly more calcium (P<0.05) than non-athletes. Athletes also consumed significantly less coffee and soft drinks than non-athletes. High school female athletes reported having dietary habits that, when combined with activity, should reduce their risk of developing osteoporosis. Future studies need to look at racial and cultural factors that might impact calcium intake in this age group.

Radioisotope scanning of the thyroid gland prior to thyroglossal duct cyst excision.

Thyroglossal duct remnants are the most common midline neck masses in childhood, representing more than 75% of such masses. Surgical treatment with the Sistrunk operation (wide excision of the cyst, duct, central hyoid, and a core of tongue base) remains the standard of care, with a low recurrence rate and minimal morbidity. Controversy exists over the appropriate preoperative evaluation of children with presumed TGD remnants since postoperative hypothyroidism can occur from inadvertent removal of the only functioning ectopic thyroid tissue. The options for evaluation include the following: • No preoperative studies • No preoperative studies; look for thyroid gland during surgery • Radioisotope scanning of the thyroid gland for all patients before surgery • Other imaging modalities, such as ultrasonography, computed tomography, or magnetic resonance imaging • Radioisotope scanning of the thyroid gland in selected patients before surgery based on a history suggestive of hypothyroidism, thyroid function tests, an inability to palpate thyroid gland, or other radiographic tests The following sections will discuss the relative merits of preoperative scanning of the thyroid gland in patients with suspected TGD remnants.

Ovarian Masses in the Pediatric Patient

Ovarian masses in the pediatric patient are uncommon. Children with ovarian tumors, however, pose diagnostic and therapeutic challenges because their presentation can mimic other more common intraabdominal disorders and their tumor histology varies widely. The refinement of surgical techniques and the advent of more effective chemotherapy in the past 25 years has increased overall survival rates from approximately 20% to 70%, thus improving the outcome for girls with malignant tumors. This article summarizes the current evaluation and management of ovarian masses in childhood and reviews pertinent pathology.

PERINEPHRIC ABSCESS MASQUERADING AS AN ANGIOMYOLIPOMA

No AccessJournal of UrologyClinical Urology: Case Reports1 Feb 1998PERINEPHRIC ABSCESS MASQUERADING AS AN ANGIOMYOLIPOMA Geoffrey J. Bisignani, Lara A. Hardesty, David S. Hartman, and Mark V. Jarowenko Geoffrey J. BisignaniGeoffrey J. Bisignani More articles by this author , Lara A. HardestyLara A. Hardesty More articles by this author , David S. HartmanDavid S. Hartman More articles by this author , and Mark V. JarowenkoMark V. Jarowenko More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63961-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PERINEPHRIC ABSCESS MASQUERADING AS AN ANGIOMYOLIPOMA." The Journal of Urology, 159(2), p. 500 References 1 : CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat.. AJR.1988; 151: 497. Google Scholar 2 : Fat density in renal cell carcinoma: demonstration with computer tomography.. J. Urol.1997; 157: 1347. Link, Google Scholar 3 : Fat containing renal mass in childhood: a case report of teratoid Wilms tumor.. J. Urol.1994; 151: 1662. Link, Google Scholar Division of Urology and Department of Radiology, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, University Hospital, Children's Hospital, Hershey, Pennsylvania.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 159Issue 2February 1998Page: 500 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information Geoffrey J. Bisignani More articles by this author Lara A. Hardesty More articles by this author David S. Hartman More articles by this author Mark V. Jarowenko More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of GH Therapy on Bone Mass in Childhood

GH stimulates bone growth, but the effect of GH on bone mass in childhood remains unclear. In this study, we analyzed the effect of GH on bone mass during childhood by using dual energy X-ray absorptiometry (DXA). Seventy-two males and thirty-eight females with GH deficiency were investigated. Bone mineral density (BMD), bone mineral content (BMC) and the projected area of the lumbar spine (L2-4) were measured by DXA before (B), after one year (1T) and after two years (2T) of GH therapy. Volumetric BMD (vBMD) was calculated by using a cylindrical vertebral model. Both BMC and area increased during GH therapy both in male and female subjects, but the L2-4BMDZ scores did not show a significant change in either sex after two years of therapy (males: Zscore B: -0.782 ± 0.698 2T: -0.927 ± 0.785, females: B: -0.782 ± 0.698 2T: -0.927 ± 0.785). Since BMD is affected by bone size, the assessment of bone mass during growth periods required volume-adjusted data. The absolute vBMD value also stayed unchanged both in male and female subjects. Therefore GH stimulated bone growth with an appropriate increase in bone mass in GH deficient patients during childhood.

Neurosarcoidosis Presenting as an Intracranial Mass in Childhood

A 13-year-old boy presented with bilateral panuveitis and a superior oblique palsy. Exhaustive laboratory workup was unremarkable, but magnetic resonance imaging (MRI) revealed an enhancing pontine mass. The mass was resected, and histopathology revealed a necrotizing granuloma. Although rare, particularly in the pediatric population, the combination of panuveitis and an intracranial mass likely represents sarcoidosis. Necrosis, although also rare, may similarly be seen in neurosarcoidosis.

Intrascrotal and testicular solid masses in childhood.

A retrospective study was performed between 1985 and 1994 on paediatric patients operated for asymptomatic intrascrotal or testicular palpable masses. Tumour was suspected in each case and it was surgically explored. Twenty-six children were affected, their age ranging between 9 days and 14 years. In 11 cases testicular torsion, in 4 epididymitis and in another 2 dystrophic calcification were found. Tumours, including rather rare alterations, were observed in only 9 children. The present results draw attention to the tumour-like occurrence of testicular torsions and other benign alterations of the scrotum.

A follow-up study on the effects of calcium-supplement withdrawal and puberty on bone acquisition of children

Recent calcium supplementation trials in children have confirmed a positive but moderate effect of calcium intake on bone mineral accretion. However, the lasting effect of a higher bone mineral mass after calcium-supplement withdrawal is not known. This is an 18-mo follow-up study conducted after an 18-mo controlled calcium supplementation trial to study the persistent effect of higher bone mineral mass in children. Radial bone mineral mass was determined by single-photon absorptiometry; lumbar spine and femoral neck bone mineral mass were evaluated by dual-energy X-ray absorptiometry in 84 healthy Hong Kong children at age 8.5 y and these evaluations were repeated at age 10 y. Pubertal status was determined by Tanner staging. At the end of the follow-up, the differences in percentage gains in lumbar spine bone mineral content (12.1 +/- 8.2% compared with 14.9 +/- 10.05%, P = 0.24) and lumbar spine area (8.6 +/- 5.1% compared with 9.4 +/- 5.5%, P = 0.47) between the study and control groups disappeared. Dietary calcium intakes during follow-up were similar for the two groups (555 and 640 mg/d, P = 0.23). In multiple-regression analyses, pubertal status was the strongest correlate of bone acquisition and linear growth in the study period. In conclusion, higher percentage gains in bone mineral mass in childhood by calcium supplementation for 18 mo were reversible. Our study showed that the benefits of calcium supplementation disappear after treatment is withdrawn. Longer-term calcium trials are necessary to determine whether peak bone mass can be modified through sustained supplementation so that appropriate calcium intakes can be determined.

Breast masses in childhood and adolescence. A presentation of 17 cases and a review of literature: A. Boothroyd and H. Carty. Pediatr Radiol 24:81–84, (April), 1994

Breast masses in childhood and adolescence. A presentation of 17 cases and a review of literature: A. Boothroyd and H. Carty. Pediatr Radiol 24:81–84, (April), 1994

The painless soft tissue mass in childhood--tumour or not?

Soft tissue malignancies are uncommon in adults and even rarer in children. Twelve children presented to the radiology department over a three-year period with a clinical diagnosis of a malignant lower limb mass. This diagnosis was usually based on the presence of a firm, painless mass. However, imaging revealed a heterogeneous group of benign pathologies: haemangioma (two cases), haematoma (two cases), aneurysm (two cases), and one case each of infection, myositis ossificans, Baker's cyst, lipoma, muscle rupture, and venous malformation. During the same period there was only one malignant soft tissue neoplasm. A variety of imaging techniques were used but ultrasound combined with colour flow Doppler was the single most helpful modality. The radiological diagnosis were confirmed by biopsy, surgery or clinical follow-up.

Fat containing renal mass in childhood: A case report of teratoid Wilms' tumor: M.A. Williams, K.P. Schropp, and H.N. Noe. J Urol 151:1662–1663, (June), 1994

Fat containing renal mass in childhood: A case report of teratoid Wilms' tumor: M.A. Williams, K.P. Schropp, and H.N. Noe. J Urol 151:1662–1663, (June), 1994

Bone density and milk Consider fat as well as calcium intake Consider fat as well as calcium intake

EDITOR, - Sean Murphy and colleagues concluded that milk consumption should be encouraged during childhood and adolescence to prevent osteoporotic fractures in later life.1 This, however, prompts several questions. Firstly, the subjects in the authors' study were asked to categorise their milk consumption without estimating their past total calcium intake. It is known that many subjects who do not drink milk consume other dairy products (cheese and ice cream). Secondly, the subjects had to recall their milk consumption up to age 25, which was a long time before the study (50 years for the 74 year old woman). It could as well be concluded that good memory makes strong bones or vice versa. If the results are reliable they lead to an interesting speculation. It is known that calcium supplementation increases bone mass in childhood.2 This does not occur later in life. Might calcium, or some other agent in dairy products, affect the developing bone in a way that later in life allows calcium intake and maintains high mineral density? I strongly disagree with the public health implications cited by Murphy and colleagues. Dietary habits are learnt in childhood and adolescence and commonly …

Fat Containing Renal Mass in Childhood: A Case Report of Teratoid Wilms Tumor

Renal masses in childhood rarely contain adipose tissue as a major component. We report a case of teratoid Wilms tumor, an atypical variant of nephroblastoma, in which bilateral renal masses were found on computerized tomography to have a high fat content. Previously reported cases have had clinical characteristics in common with our case. However, our patient died of metastatic disease, which to our knowledge has not been previously described.

Breast masses in childhood and adolescence. A presentation of 17 cases and a review of the literature.

Breast masses are uncommon in the first two decades of life. 17 girls aged between 2 and 15 years who presented over a 5-year period are reviewed retrospectively. The cases comprised inflammation (11), asymmetrical gynaecomastia (1), precocious puberty (1), giant juvenile fibroadenoma (1), primary rhabdomyosarcoma (1), lymphoma (1), and metastatic neuroblastoma (1). Ultrasound was useful in all cases in identifying the abnormality and guiding any further investigation.

Ureteric Cyst: An Unusual Abdominal Mass

Abdominal cystic masses in childhood are rare and despite improved imaging techniques continue to present diagnostic confusion. Typically such cystic lesions are mesenteric or intestinal in origin. However, rarer causes include cystic dilatation of a blind ending ureter. To date over 100 cases of blind ending ureters have been reported and their management described. We report on a case of non-communicating ureteric cyst associated with a blind ending ureter that recurred following percutaneous drainage and required operative resection. Although percutaneous drainage techniques have been advocated for a variety of abdominal cystic lesions, the experience gained from this case suggests that operative excision is the treatment of choice.

CT of focal pulmonary masses in childhood.

Focal pulmonary masses in children encompass a spectrum of conditions including congenital lesions, inflammatory masses, hematomas, and benign and malignant tumors. Congenital masses include bronchial atresia, sequestration, cystic adenomatoid malformation, and pulmonary vascular anomalies. Inflammatory masses most commonly result from infection and include pulmonary abscess, granulomas, and postinflammatory pseudotumors. Blunt trauma can cause a hematoma, which decreases in size on serial radiographs. Pulmonary neoplasms may be benign such as papilloma, hamartoma, and bronchial carcinoid tumor (low-grade malignancy), or they may be malignant as in sarcoma, carcinoma, and pulmonary blastoma. Because computed tomography (CT) is the most sensitive technique in detecting and helping characterize parenchymal disease, it has become the procedure of choice for further investigation of lesions seen or suggested on plain chest radiographs. Understanding the CT appearance of these lesions can allow an accurate diagnosis and optimize management of the patient's condition.