Masses In Children Research Articles

Pancreatic Masses in Children and Young Adults: Multimodality Review with Pathologic Correlation.

Masses and masslike lesions of the pancreas are uncommon in the pediatric population. However, owing to overlapping clinical and imaging features, it can be challenging to differentiate the various causes of pediatric pancreatic masses at initial patient presentation. Clinical data such as patient age, signs and symptoms at presentation, laboratory test results, and potential underlying cancer predisposition syndrome can be helpful when formulating a differential diagnosis. US may be the first imaging study to depict a pancreatic mass in a child, as this examination is frequently performed in children with nonspecific abdominal signs and symptoms because of its wide availability and relatively low cost and the lack of a need for sedation or anesthesia. CT or MRI is typically required for more thorough characterization of the mass and surgical planning. Complete characterization of pancreatic masses includes assessment of vascular involvement, local invasion, and extrapancreatic spread of tumor. The authors provide an up-to-date comprehensive review of the clinical manifestations, histopathologic features, and imaging findings of primary and secondary tumors of the pancreas in children and young adults. Advances in imaging, current prognostic information, and treatment paradigms also are highlighted. Finally, nontumorous masslike lesions of the pediatric pancreas, including vascular malformations, cystic disorders (eg, von Hippel-Lindau syndrome, cystic fibrosis), intrapancreatic accessory spleen, and autoimmune pancreatitis, are discussed. Online supplemental material is available for this article. ©RSNA, 2021.

Comparison between Conservative Treatment Andappendectomy for Managing Appendicular Mass in Children

Appendectomy is considered the first treatment choice for appendicitis. However, controversy existssince conservative therapy is associated with fewer complications than appendectomy for patients with appendicular mass. Twenty onechildren underwent to appendectomy (Group I) , and sixty children on conservative therapy (Group II)were included in this study . The study was conducted at Al-Zahra Teaching Hospital in Al-Najaf city, in Iraq , during the period between October 2020 to January 2021 .The results of the current study show that there is a significant difference in laboratory Investigation (p value = 0.04) , Fever(p value = 0.001), hospital stay/ days(p value = 0.02) and duration of symptoms(p value = 0.003) between group I and group II .The study concluded that the appendectomy may result in better outcomes and less complication than conservative therapy in children with appendicular mass .

The Pattern of Presentation of Abdominal Masses in Children

Background; The abdominal masses in infants, neonate or child is a worrying sign that every clinician must be aware of as these masses can sometimes show malignant transformation. The outcome of this study would give an overview to the paediatric surgeons/ urologist about presenting spectrum of abdominal masses in children in our population which would enable them to manage these patients properly. Study Design: A Descriptive Cross-sectional Study conducted at Children Hospital, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS Islamabad and Urology department of Islam Medical College/ Teaching Hospital, Sialkot for the duration of one year from January 2022 to December 2022. Material & Methods: This descriptive cross sectional study include ninety four (n=94) patients of less than 12 years of age irrespective of either gender who presented with abdominal mass. Patients suspected of having abdominal mass were screened from the outpatient (OPD) and emergency departments. Results; Out of 94 children, sixty five (69.15%) children were males whereas twenty nine (30.85%) were females. The male to female ratio was 2.24:1. Thirty five (37.33%) children were less than 1 year old, Twenty six (27.66%) were between age 1 and 3 years, nineteen (20.12%) children were between age 3 to 7 years and fourteen (14.89%) of children were elder than 7 years of age. The mean age was 7.4 months ± 2.1 Standard Deviation (SD). Most of the masses are benign and cystic in nature, however, Wilms’ tumour and neuroblastoma are two conditions that need a vigilant monitoring as these are the two malignant tumours (22.34% : n=21) in children where they usually present with abdominal mass. Conclusion; In a nutshell, any child presented with abdominal symptoms in surgical department must be investigated and managed accordingly. Any delay in diagnosis may cause fatal outcome. Keywords: Abdominal mass, UPJO-ureteropelvic junction obstruction, VUR (vesico-ureteric reflux), Hydronephrosis.

Clinical Spectrum and Management of Ovarian Masses in Children and Adolescent up to 20 Years of Age

Pathological type as well as management of ovarian tumor in the pediatric population are different than adult women. We performed a retrospective analysis of clinical and diagnostic aspects of ovarian tumors and tumor-like lesions in girls in order to identify characteristics associated with malignancy and it’s clinical management which is different from adult women. This is a descriptive type of cross sectional study was condunted among seventy nine female children and adolescent admitted in Bangabandhu Sheikh Mujib Medical University (BSMMU) with ovarian mass from January 2017 to December 2020. Secondary data were collected from hospital record review. The demographic data, diagnostic procedure, management and histopathological analysis of the ovarian tumor were recorded. Mean age of study population was 16.7±3.1 and age range was 8-20 Years. Benign and malignant ovarian tumor was 40.50% and 59.49% respectively. The main symptom and sign were abdominal pain and palpable mass were found in 51% and 50% cases respectively. Malignant lesion appeared as cystic in 22.44%, solid 44.89% and mixed in 32.65% cases. But benign ovarian tumor was found predominantly as cystic in 70% cases preoperatively. More than three fourth (75.51%) of malignant ovarian tumor showed one or more positive tumor marker whereas one third (33.33%) benign tumor had raised tumor marker. Large lesions in both benign and malignant cases were found in almost similar number of cases and these were 80% and 81% respectively. In the group of solid tumors, positive tumor marker results occurred more frequently in patients with malignant tumor (57.14%). Elevated serum alpha feto protein (AFP), Human Chorionic Gonadotrophin (HCG) and high Lactate Dehydrogenage (LDH) value associated more often with malignant tumor. Laparotomy was performed in all cases of study population. Among 49 malignant ovarian tumour 34 (69.3%) underwent ovary preserving surgery. All patient with benign ovarian tumor undergone conservative surgery. Predominantly solid structures noted on imaging studies, large dimension and positive tumor markers are clinical predictors of malignancy. Multicenter prospective studies are needed to improve and unify the ovarian preservation rates across the world.
 Bangladesh Med J. 2021 January; 50(1) : 1-9

Association of Sleep Quality With Greater Left Ventricular Mass in Children Aged 9 to 11 Years.

Research has consistently found associations between sleep characteristics and cardiovascular disease risk in children, adolescents, and adults. Although primarily investigated in clinical samples (e.g., in those with sleep disorders), greater left ventricular mass is associated with poor sleep quality in nonclinical adult populations as well; however, this has not been evaluated in children or adolescents. Our study aim was to consider the relationship between objectively measured sleep characteristics and left ventricular mass in children. We assessed sleep and cardiac structure in a biracial sample of 9- to 11-year-old children (n = 176; 41% White, 59% Black; 50% female). Sleep was assessed with actigraphy for five nights. Cardiac dimensions were assessed using echocardiography. After adjusting for covariates, we found that poor sleep quality was associated with significantly greater left ventricular mass (β = 0.13, t(167) = 2.14, p = .034, Cohen d = 0.16, for activity during sleep; β = 0.15, t(167) = 2.43, p = .016, Cohen d = 0.18, for sleep fragmentation). Other cardiac dimensions (namely, relative wall thickness and right ventricular dimension) were also significantly associated with sleep characteristics. Notably, associations did not differ as a function of sex or race. The present findings are novel and unique because no prior reports have systematically documented the association between poor sleep quality with potentially detrimental cardiac remodeling in a nonclinical sample of children. However, the novelty and importance of these findings require additional research for confirmation.

Clinico Pathological Review of Adnexal Masses in Children and Adolescents at a University Hospital

Background & Objective: The study objective was to review the clinic-pathological characteristics of adnexal masses in the children and adolescent population in our institution. Methods: Retrospective analysis of 178 adolescent patients including neonates, presenting with adnexal masses between January 2000-December 2012, was performed. Results: Records of a total of 178 patients were analyzed. The mean age was 14 years. The most common symptom was abdominal pain noted in 146(82%) patients followed by nausea and vomiting in 28(15.7%) and incidental findings in 19(10.7%). The majority of the ovarian masses were benign. The follicular cyst was the most common histopathological type in 66 patients (37.1%) followed by a hemorrhagic cyst in 40(22.5%), benign teratoma in 21(11.8%), benign serous cyst in 20 patients (11.2%), endometrioma and mucinous cystadenoma in 13 patients (7.3%). The average tumor size observed in the present study was 7.84cms. However, the size varied in different age groups such as 4.27 cm size in neonates, and 7.1 cm in 1-14 years age group, and 8.61 cm in 15-19 years age group with a P-value of 0.009. Out of a total of 178 patients, 46(25.8%) were managed conservatively. However, 90(50.6%) patients underwent ovarian cystectomy, 26(14.6%) were managed by unilateral salpingo-oophorectomy, 10(5.6%) by unilateral oophorectomy. Aspiration and biopsy were done in 6(3.4%) patients. Conclusion: Incidence of adnexal masses increases with age with maximum cases between age 14 and above. Adolescent girls with adnexal masses can have variable presentations however abdominal pain is the most common symptom. Mostly these are benign masses therefore conservative approach for treatment should be adopted.

О ДЕТСКОМ СЕГМЕНТЕ МУЗЫКАЛЬНОЙ МАССМЕДИА КУЛЬТУРЫ XXI ВЕКА

The children's segment of culture — "music about children" and "music for children", being formed in the media environment, under new conditions needs close attention of scientists and updating of analytical tools for research. Acquiring features and qualities that differ from those previously inherent, this area requires scientific comments on various parameters — in terms of dynamics, prevailing directions, etc., opening new horizons for studying musical culture of the information community. The article discusses the possibilities of using search engines (Google, Yandex) to review children's musical products in the media space of modern society. The changing environment and conditions for musical culture determine the necessity of new approaches, including those from marketing technology for researching the content of genre trends, studying consumer interest, obtaining statistical information, etc. With the help of Internet applications (Trends, Wordstat) there is a prospect to analyze musical and cultural reality of society in the web search mode, revealing the comparative degree of popularity of different objects, in this case, related to the children's mass media sphere. The results obtained allow to state the predominant demand for entertainment products, which is a general trend in cultural life, regardless of the age category of consumers.

Thymic Cyst: An Unusual Cause of Cervical Mass in Children: A Case Report

Thymic Cyst: An Unusual Cause of Cervical Mass in Children: A Case Report

Appendicular Mass in Children: Our Experience with Early Appendectomy

Abstract Acute appendicitis remains the commonest cause of acute abdomen in children with appendicular mass as one of its common sequelae. Management of these cases can be surgical or via a conservative approach. Our study aims to express our experience as regarding the feasibility and outcome of early surgical intervention of appendicular mass in children. Patients and Methods: Our study included 48 cases of fixed appendicular mass, diagnosed by clinical examination and radiological investigations. Early surgical intervention were done for these cases either by laparoscopic or open approach. The operative complications, post-operative course, hospital stay and follow-up data were assessed. Results: In this study, 48 patients were included (26 females and 22 males), their ages ranged from 4 to 12 years with the mean age was 7.8 years. Open appendectomy was done in 34 patients and laparoscopic approach in 14 cases with conversion of two cases from laparoscopy to open approach. Symptoms and signs included vomiting, fever, abdominal pain, tenderness and palpable abdominal mass. Appendicular mass formed of bowel loops and omentum without pus formation was detected in 42 (87.5%) patients while localized pus collection in the mass was detected in 5 (10.4%) patients and frank appendicular abscess was detected in 1 patient (2.08%). Bowel injury happened in two cases (4.2%), diagnosed and managed intraoperatively and passed smoothly. Residual pus collection occured in 4 cases (8.4%). Two cases treated conservatively, while laparoscopic drainge cured the other two. Wound infections had occurred in 8 cases 16.6%). These cases were treated by IV antibiotics. Two case needed drainge and the wound layers were dissected. Conclusion: Early surgical intervention of appendicular mass in children is safe, effective and reliable approach with good outcome and low rate of complications.

Causative Organism of Infectious Renal Masses in Children in a Developing Country and Their Management.

The article's abstract is not available.

Blood Pressure and Body Weight Have Different Effects on Pulse Wave Velocity and Cardiac Mass in Children.

Background: High blood pressure (BP) and excess weight can lead to early cardiovascular organ damage already in children. Carotid-femoral pulse wave velocity (cf-PWV) is the non-invasive gold standard method for assessing aortic stiffness, while carotid-radial PWV (cr-PWV) provides information on the distensibility of the upper limb arteries. The aim of this study was to evaluate the relationship of BP and BMI z-scores with arterial stiffness and left ventricular mass index (LVMI) in a pediatric population. Methods: In 343 children (57.7% males; age ± SD 11.7 ± 2.9 years), systolic (SBP) and diastolic (DBP) BP, BMI, cf-PWV, cr-PWV and LVMI were measured. A multiple linear regression model was used to assess the impact of BMI and SBP (or DBP) z-scores on cf-PWV, cr-PWV and LVMI. Results: About 21% of children were normal weight, 34% were overweight and 45% obese. Adjusted for possible confounders, SBP and DBP z-scores were significantly associated with cf-PWV (p < 0.001), while only DBP z-scores were related to cr-PWV (p < 0.01). BMI was neither associated with cf-PWV nor with cr-PWV values but was a strong predictor of LVMI (<0.001), whereas cardiac mass and BP z-scores were not related. Conclusions: Our study suggests that, in children, elevated BP values and excess weight may have different effects on the heart and the vessels in causing early cardiovascular alterations.

Pearls and Pitfalls in the Imaging of Soft-Tissue Masses in Children

There is a broad spectrum of soft-tissue masses in children that can be challenging to diagnose clinically and on imaging. This article reviews the typical clinical and imaging findings of the most common and relevant benign, intermediate and malignant pediatric soft-tissue tumors in the following categories of the 2013 World Health Organization (WHO) classification: adipocytic tumors (lipoma, lipoblastoma, and liposarcoma), fibroblastic/myofibroblastic tumors (nodular fasciitis, myositis ossificans, fibrous hamartoma of infancy, fibromatosis colli, desmoid-type fibromatosis, lipofibromatosis, and infantile fibrosarcoma), pericytic tumors (myofibroma/myofibromatosis), skeletal muscle tumor (rhabdomyosarcoma), nerve sheath tumors (neurofibroma, malignant peripheral nerve sheath tumor), and uncertain differentiation (synovial sarcoma). In general, ultrasound and magnetic resonance imaging are used as first- and second-line imaging modalities, with limited roles for plain radiographs, computed tomography, and fluorodeoxyglucose-positron emission tomography. Many of these tumors have nonspecific imaging findings although there are some key imaging clues that in conjunction with the clinical information allow a specific diagnosis or a narrow differential diagnosis. However, in many instances, histology is required for final diagnosis.

Leukocyte–Endothelium Interaction Is Associated with Fat Mass in Children

To study leukocyte-endothelium interaction, a measure of the initial phase of atheromatosis, in children with overweight or obesity. A prospective study was conducted in 77 children aged 7-16years; 47 were children with overweight/obesity and 30 were normal weight. Polymorphonuclear neutrophils (PMNs) and peripheral blood mononuclear cells were isolated from venous blood samples and the interaction of leukocytes over a monolayer of human umbilical vein endothelial cells was analyzed using flow chamber microscopy. The variables studied included leukocyte rolling velocity, rolling flux, and adhesion to endothelial cells. These were compared between children with overweight/obesity and control children. Correlation between the measures of leukocyte-endothelium interaction and anthropometric and biochemical variables was evaluated. In comparison with normal weight children, the PMNs and peripheral blood mononuclear cells of the overweight/obesity group showed a reduction in rolling velocity (P=.000 and P=.001, respectively) and an increase in rolling flux (P=.001 and P=.004), and adhesion (P=.003 and P=.002). The homeostasis model of insulin resistance was correlated inversely with rolling velocity and positively with rolling flux in PMNs. C-reactive protein was correlated positively with rolling flux and adhesion in both types of leucocytes. Fat mass index was correlated with all measures of leukocyte-endothelial interaction and proved to be the main predictor of leukocyte adhesion in the multiple regression analysis (P=.001 for PMNs and P=.006 for peripheral blood mononuclear cells). Excess fat mass in children is related to the activation of the leukocyte-endothelium interaction, potentially contributing to the development of atherosclerosis.

New-born with Cervical Ectopic Thymus: An Uncommon Developmental Disorder Which Has to be Consider in the Differential Diagnosis of Unilateral Neck Mass in Children

New-born with Cervical Ectopic Thymus: An Uncommon Developmental Disorder Which Has to be Consider in the Differential Diagnosis of Unilateral Neck Mass in Children

Family and Lifestyle Factors Mediate the Relationship between Socioeconomic Status and Fat Mass in Children and Adolescents

Socioeconomic status (SES) is strongly associated with childhood overweight. The underlying mechanism and the role of family and lifestyle factors as potential mediators of this relationship remain, however, unclear. Cross-sectional data of 4,772 girls and boys aged 5–16 years from the Kiel Obesity Prevention Study were considered in mediation analyses. Fat mass (FM) was assessed by bioelectrical impedance analysis and converted into a percent FM SD score (FM%-SDS). SES was defined by the parental educational level, classified as low, middle, or high. Characteristics of family and lifestyle factors were obtained via validated questionnaires and considered as mediators. In 3 different age groups, the product-of-coefficients method was used to examine age-specific mediator effects on the relationship between SES and FM%-SDS (c = total effects) and their ratio to total effects, adjusted for age, sex, puberty, and nationality. The prevalence of overweight was 6.9%. In all age groups, SES was inversely associated with FM%-SDS as follows: 5–7 years, c₁ = –0.11 (95% CI –0.19 to –0.03); 9–11 years, c₂ = –0.21 (95% CI –0.27 to –0.14); and 13–16 years, c₃ = –0.23 (95% CI –0.28 to –0.17). The relationship between SES and FM%-SDS was fully (5–7 and 9–11 years) and partly (13–16 years) mediated by similar and age-specific mediators, including parental BMI, parental smoking habits, media consumption, physical activity, and shared meals. Overall, these variables resulted in a total mediating effect of 77.8% (5–7 years), 82.4% (9–11 years), and 70.6% (13–16 years). Consistent for both sexes, the relationship between SES and FM%-SDS was therefore mediated by parental weight status, risk-related behavior within families, and children’s and adolescents’ lifestyle factors. Strategies for obesity prevention, which are predominantly targeted at socially disadvantaged groups, should therefore address the family environment and lifestyle factors.

Analysis of vertical vibrations affecting a child transported in a child seat during a car passing over the release speed bump

The article presents the results of research on the assessment of vibrational comfort of children carried in child seats. The work analyzes the impact of the child's mass and the speed of the car passing through the speed bump on the level of vibration to which the passenger (child) transported in the child seat mounted on the rear seat of the car is exposed. The tested car seats were installed in a passenger car using the ISOfix base. During the tests, the measured values were the acceleration of the seat child seat, the backrest of the child seat, the rear seat of the car and the child seat ISOfix base. As part of the research, car drive through the speed bump were carried out at different car speeds and with different mass simulating the mass of a child. The test results were analyzed in order to determine the magnitude of vibrations generated during car drive through the speed bump. Based on the results obtained, the level of vibrational comfort of a child trip in a child seat was assessed.

The Appendicular Lean Mass Index Is a Suitable Surrogate for Muscle Mass in Children with Cerebral Palsy

Densitometrically measured lean body mass (LBM) is often used to quantify skeletal muscle mass in children with cerebral palsy (CP). Since LBM depends on the individual's height, the evaluation of $\frac{{{\rm{LBM}}}}{{heigh{t^2}}}\ $ (lean BMI) is often recommended. However, LBM includes not only skeletal muscle mass but also the mass of skin, internal organs, tendons, and other components. This limitation applies to a far lesser extent to the appendicular lean mass index (LMIapp). The aim of the study was to evaluate skeletal muscle mass in children with CP using total lean BMI (LMItot) and LMIapp. The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation program. In total, 329 children with CP [148 females; Gross Motor Function Classification Scale (GMFCS) I, 32 children; GMFCS II, 73 children; GMFCS III, 133 children; GMFCS IV, 78 children; and GMFCS V, 13 children] were eligible for analysis. The mean age was 12.3±2.75 y. Pediatric reference centiles for age-adjusted LMIapp were generated using data from NHANES 1999-2004. Low skeletal muscle mass was defined as a z score for DXA determined LMItot and LMIappless than or equal to-2.0. The z scores for LMIapp were significantly lower than LMItot in children with CP, GMFCS levels II-V (P<0.001), with the exception of GMFCS level I (P=0.121), where no significant difference was found. The prevalence of low LMItot (16.1%; 95% CI: 16.1, 20.1%) was significantly lower (P<0.001) than the prevalence of LMIapp (42.2%; 95% CI: 36.9, 47.9%) in the study population. The prevalence of low skeletal muscle mass in children with CP might be underestimated by LMItot. LMIapp is more suitable for the evaluation of skeletal muscle mass in children with CP.

Muscle Mass in Children and Adolescents: Proposed Equations and Reference Values for Assessment.

Objectives: The goal of this study was to develop regression equations to estimate LM with anthropometric variables and to propose percentiles for evaluating by age and sex.Methods: A cross sectional study was conducted with 2,182 Chilean students (1,347 males and 835 females). Ages ranged from 5.0 to 17.9 years old. A total body scan was carried out with the double energy X-ray anthropometry (DXA) to examine and measure lean muscle mass of the entire body. Weight, height, and the circumference of the relaxed right arm were also measured.Results: Four anthropometric equations were generated to predict lean mass for both sexes (R2 = 83–88%, SEE = 3.7–5.0%, precision = 0.90–0.93, and accuracy = 0.99). The Lambda-mu-sigma method was used to obtain the sex-specific and age-specific percentile curves of lean mass (p3, p5, p10, p15, p25, p50, p75, p85, p90, p95, and p97).Conclusion: The four proposed equations were acceptable in terms of precision and accuracy to estimate lean mass in children and adolescents. The percentiles were created by means of anthropometric equations and real values for DXA. These are fundamental tools for monitoring LM in Chilean children and adolescents of both sexes.

OR53: Neighborhood Environment Mediates the Relationship Between Socioeconomic Status and Fat Mass in Children and Adolescents

OR53: Neighborhood Environment Mediates the Relationship Between Socioeconomic Status and Fat Mass in Children and Adolescents

Inverse Association of High-Density Lipoprotein Cholesterol Concentration with Muscle Mass in Children.

Background: Obesity was often associated with low high-density lipoprotein (HDL) cholesterol concentration, which is an established cardiovascular risk factor. Objectives: To evaluate the association of HDL-cholesterol concentration with fat and muscle mass in children and adolescents. Methods: Data of the National Health and Nutrition Examination Survey (1999-2004) were used to estimate fat and muscle mass by dual-energy X-ray absorptiometry (DXA) of the participants who had also an examination of their lipid profiles. Fat mass was assessed by DXA-determined fat mass index (FMI). Muscle mass was operationalized by appendicular lean mass index (LMI). Low HDL-cholesterol concentration was defined as <40 mg/dL. Results: For the evaluation of the association of HDL-cholesterol concentration with FMI and LMI Z-scores, the data of 6288 children and adolescents (age 8-19 years) (2535 females) were eligible. In the study population, the prevalence of low HDL-cholesterol concentration increased with rising FMI and appendicular LMI Z-scores. Conclusions: The study results suggested that there is a counterintuitive, inverse association of muscle mass and HDL-cholesterol concentration.