Pathological Findings In Children Research Articles

The spectrum and changes of biopsy-proven kidney diseases in Chinese children.

The study aimed to investigate the spectrum of biopsy-proven kidney disease in Chinese children. Records of children 0-17years old who underwent native kidney biopsy from June 1st, 2013 to December 31st, 2018 in the national inpatients' database of China were analyzed. Biopsy-proven kidney diseases of different sex, age groups, and diagnosis, and the changing patterns of kidney disease compared with the previous study were analyzed. A total of 21,311 patients from 232 hospitals with a median age of 11.34years were included. Immunoglobulin A vasculitis with nephritis (IgAVN) was the most common pathological finding [29.17%, 95% confidence interval (confidence interval, CI) = 28.56-29.78], followed by IgA nephropathy (IgAN) (22.70%, 95% CI = 22.14-23.27). IgAN was the most common finding in patients with hematuria (60.75%, 95% CI = 58.83-62.65], proteinuria (33.43%, 95% CI = 30.54-36.42), and hematuria plus proteinuria (62.77%, 95% CI = 56.19-69.02). Minimal change disease was the most common finding (40.69%, 95% CI = 39.41-41.98) in nephrotic syndrome. The proportion of IgAVN in patients with biopsy-proven glomerular disease increased year by year during 2013-2018 (p for trend < 0.001) and washigher than that of2004-2014 [29.41% (95% CI = 29.10-29.72) in 2013-2018 vs. 13.35% (95% CI = 12.97-13.73) 2004-2014, p < 0.001]. The proportion of hepatitis B virus associated nephritis during 2013-2018 was lower than that of 2004-2014 [0.44% (95% CI = 0.36-0.54) in 2013-2018 vs. 0.87% (95% CI = 0.67-1.10) in 2004-2014, p < 0.001]. IgAVN and IgAN were the most common types of pathological findings in children who underwent kidney biopsies from 2013 to 2018. The pathological spectrum of kidney biopsy changed over time.

Clinical radiological and pathological staging of children with hypersensitivity pneumonitis.

Hypersensitivity pneumonitis (HP)is rare in the pediatric population. To date, there are no studies defining a correlation between clinical, radiological, and pathological findings in children with HP. The objective of this study is to define the clinical, and radiological characteristics and prognosis of childhood HP and to examine the clinical, radiological, and pathological correlation between HP stages. Patients with suspected HP and followed at two tertiary care hospitals between 2000 and 2020 were retrospectively evaluated. Computed tomography (CT) of the chest of patients was evaluated by a single radiologist. The interagreement between clinical and radiological severity of the patients was calculated with the κtest. Fourteen children with suspected HP were identified. The results of 10 patients with the definitive diagnosis were as follows: one patient (10%) had acute, fivepatients (50%) had subacute, andfour patients (40%) had chronic HP. The most prominent findings in chest CT were hilar, or hilar and subcarinal lymphadenopathy (80%), centrilobular nodules (60%), patchy or diffuse ground-glass opacities (50%), and cysts (50%). The interagreement between clinical and radiological severity of the patients was 100% (approximate significance: 0.003). The diagnosis of four patients with suspected HP who were unresponsive to standardized medical treatments or developed multisystem involvement was diagnosed with other diseases. One patient (10%) with definitive chronic HP died due to respiratory failure during follow up. Similar to adult HP, the prognosis is worse in children with existing fibrotic equivalents in chest CT. Patients who are not responding to standard medical treatments or develop multisystem involvement should be evaluated for other lung diseases.

Adenoid hypertrophy is a common finding in children with antrochoanal polyp

BackgroundMany nasal pathological findings have been described with antrochoanal polyp (ACP). We aimed in this study to assess the prevalence of adenoid hypertrophy among children presented with ACP and to evaluate the efficacy of concomitant adenoidectomy on the outcome of endoscopic removal of the lesion.ResultsForty-three children with ACP were included in this study. Preoperative nasal endoscopy and computed tomography were performed for all patients. Endoscopic sinus surgery (ESS) with widening the maxillary ostium was used for removal of ACP in all patients. Associated nasal pathology was recorded and managed accordingly. The patients were followed up for at least 3 years postoperatively. Coexistent nasal pathology with ACP was detected in 39 patients (90.7%); adenoid hypertrophy was found to be the commonest concomitant lesion (83.7%). Adenoidectomy was performed during ESS for those who had adenoid hypertrophy. Postoperatively, no patients developed adenoid regrowth; however, recurrence of ACP was detected in five patients (11.6%).ConclusionAdenoid hypertrophy is a common pathological finding in children presented with ACP. Endoscopic removal of ACP with concomitant adenoidectomy is an effective procedure and has a favorable outcome.

Upper-Limb Entheses in Healthy Children: A Comprehensive Ultrasound Study.

Interest in ultrasound (US) as a diagnostic tool in spondyloarthritis is growing. Although the literature has provided detailed description of normal lower-limb entheses for adults and children, validated normal US findings of the pediatric upper-limb (UL) entheses are lacking. The aim of this study was to describe the sonographic characteristics of the UL entheses in healthy children to provide a basis for assessing pathologic findings in children with rheumatic diseases. This is an observational, cross-sectional study. The recruited healthy children were grouped according to age: group 1, 3-9 years (n = 22); group 2, 10 to 13 years (n = 12); and group 3, 14 to 18 years (n = 9). The following UL entheses were examined: (1) supraspinatus, (2) common flexor, (3) common extensor, and (4) triceps. Ultrasound examination was performed in B mode for morphology and structural abnormalities, and power Doppler was applied to detect vascularization within the enthesis and cartilage sites. Forty-three children with a median age of 9 years (6-13 years) were included; 55% were boys. A total of 344 entheses were evaluated; all of them presented a homogeneous hyperechoic fibrillar pattern. Tendon insertion thickness at the bone attachment site increased with age and was greater in males. No signs of chronic enthesopathy were detected. Doppler signal was observed in children from groups 1 and 2, but not in any of the patients in group 3. In group 1, intraentheses signal was detected in the common extensor tendon insertion as an isolated signal (n = 2 patients), whereas intracartilage signal was detected in the supraspinatus (n = 1 patient) and the triceps (n = 1 patient). In group 2, intracartilage signal was detected in the common extensor (n = 2 patients) and the common flexor (n = 2 patients). Interobserver agreement for the entheses' thickness was as follows: intracorrelation coefficient class (ICC) of 0.86 (95% confidence interval [CI], 0.84-0.92) for the supraspinatus enthesis, ICC of 0.83 (95% CI, 0.83-0.90) for the common extensor enthesis, ICC of 0.96 (95% CI, 0.91-0.97) for the common flexor enthesis, and ICC of 0.94 (95% CI, 0.89-0.95) for the triceps enthesis. The κ index was 0.93 for the detection of the power Doppler signal. Intraobserver agreement was good for all evaluated entheses: ICC of 0.85 (95% CI, 0.83-0.91) for supraspinatus, ICC of 0.86 (95% CI, 0.84-0.91) for common extensor entheses, ICC of 0.89 (95% CI, 0.86-0.93) for common flexor entheses, and ICC of 0.96 (95% CI, 0.90-0.97) for evaluation of triceps entheses. The κ index was 0.91 for the detection of Doppler signal. The current study provides a comprehensive description of the structural appearance and vascularization of UL entheses on healthy children. This information can be useful as reference for interpretation of pathological findings in children with musculoskeletal diseases in clinical practice.

International consensus classification of hippocampal sclerosis and etiologic diversity in children with temporal lobectomy

IntroductionThe distribution of hippocampal sclerosis (HS) subtypes, according to the classification of the International League Against Epilepsy (ILAE), has been reported mainly in adult patients. We aimed to review the pathological findings in children who had anterior temporal lobectomy accompanied with amygdalohippocampectomy, in view of the current classification, and evaluate postsurgical outcome with respect to HS subtypes in childhood. MethodsSeventy children who underwent temporal resections for treatment of medically refractory epilepsy, with a minimum follow-up of 2 years, were included; the surgical hippocampus specimens were re-evaluated under the HS ILAE classification. ResultsNeuropathological evaluations revealed HS type 1 in 38 patients (54.3%), HS type 2 in 2 (2.8%), HS type 3 in 21 patients (30%), and no HS in 9 patients (12.9%). Of 70 patients, 23 (32.9%) had dual pathology, and the most common pattern was HS type 3 with low-grade epilepsy-associated brain tumors (LEAT). The distribution of HS types with respect to age revealed that HS type 3 and no HS subgroups had significantly more patients younger than 12 years, compared with those of HS type 1 (90.5%, 77.8% vs 47.4%, respectively). History of febrile seizures was higher in HS type 1. Prolonged/recurrent febrile seizures were most common in patients 12 years and older, whereas LEAT was the most common etiology in patients under 12 years of age (p < 0.001). Patients with HS type 1 had longer duration of epilepsy and an older age at the time of surgery compared with patients with HS type 3 and no HS (p: 0.031, p: 0.007). At final visit, 74.3% of the patients were seizure-free. Seizure outcome showed no significant difference between pathological subtypes. ConclusionsOur study presents the distribution of HS ILAE subtypes in an exclusively pediatric series along with long-term seizure outcome. The study reveals that the leading pathological HS subgroup in children is HS type 1, similar with adult series. Hippocampal sclerosis type 2 is significantly less in children compared with adults; however, HS type 3 emerges as the second most predominant group because of dual pathology, particularly LEAT. Further studies are required regarding clinicopathological features of isolated HS in pediatric cohort. Seizure-free outcome was favorable and similar in all HS types in children. The proportion of HS types may be better defined in pediatric patients with temporal resections, as the current HS ILAE classification becomes more widely used, and may help reveal the surgical and cognitive outcome with respect to HS types.

Coronavirus disease 2019 (COVID-19) and pediatric gastroenterology.

The coronavirus disease 2019 (COVID-19) is responsible for the new pandemic, which remains an important health and economic challenge worldwide. The causative agent is a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is similar to SARS-CoV-1 and Middle East respiratory syndrome coronavirus (MERS-CoV). Adult infection with respiratory symptoms was considered in the beginning of the pandemic. Now, it has been reported that SARS-CoV-2 infects children and other organs such as the gastrointestinal tract. SARS-CoV-2 enters the host cells through angiotensin converting enzyme-2 (ACE2) receptors as the main receptor expressed in various organs such as the lungs and gastrointestinal tract. Studies on children and the clinical manifestations of COVID-19 do not completely explain the natural course of infection in children, and precisely how the GI tract is involved is not understood. The present article highlights the gastrointestinal manifestations and pathological findings in children with COVID-19. According to the evidence, SARS-CoV-2 infection is milder in children and may present different clinical symptoms from adults. Common clinical manifestations of pediatric COVID-19 include cough, fever, sore throat, malaise, fatigue, and GI symptoms such as diarrhea, abdominal pain, nausea, and vomiting. Furthermore, liver and pancreatic enzymes may be elevated during the pediatric COVID-19 course. Asymptomatic children carriers are potential sources of infection for adults, especially elderly ones. Diagnosis, treatment, and isolation of children are the most effective ways to control the expansion of the COVID-19 pandemic.

Clinicopathological report of children and young adults with nephrotic syndrome undergoing renal biopsy at workshops in Port Harcourt, Nigeria

Background: Kidney biopsy is a procedure that is not commonly performed in Nigeria. This study reports the clinical and pathological findings in children who underwent renal biopsies during nephrology workshops held in Port Harcourt in 2014 and 2015. Methods: The native kidney biopsies were processed and evaluated with light microscopy only. Results: Nineteen patients (10 females) were biopsied. The mean age was 11.0 ± 6.5 years and the range was 1.8 to 21 years. Eleven patients had steroid-dependent nephrotic syndrome (SDNS) while eight were steroid-resistant (SRNS). Hypertension and haematuria were present more often in SDNS. There were 11 cases (57.9%) with non-proliferative lesions, including minimal change disease (4 cases), focal segmental glomerulosclerosis (4 cases) and collapsing glomerulopathy (3 cases). The proliferative lesions (8 cases) included membranoproliferative (mesangiocapillary) glomerulonephritis (MPGN, 5 cases), mesangial proliferative glomerulonephritis (2 cases) and MPGN with collapsing glomerulopathy (1 case). Overall, the most common pathologic diagnosis was MPGN (26.3%). Hypertension was more common with proliferative than non-proliferative lesions (62.5% versus 36.4%). Conclusions: Although MPGN was the most common morphologic lesion among children with nephrotic syndrome, bigger studies are necessary to confirm this. Efforts should be intensified in acquiring the expertise and infrastructure for performing and interpreting renal biopsies in Port Harcourt order to optimize patient management.

64. Transcranial magnetic stimulation in children: Collection of normative values from the lower limbs

The aim of this study is to collect normative data of Transcranial-Magnetic-Stimulation (TMS) in pediatric age. 46 healthy children (2–14 years, ranges: 2–5; 5–8; 8–10; 10–12; 12–14; M:F = 25:21) were tested with TMS, with an intensity stimulation of 70–80% of resting motor threshold. All children were free of neurologic, psychiatric and serious medical illness, not taking any neuropsychiatric medications, and did not have any contraindication to TMS. A statistic analysis of results noticed a correlations between the cortico-spinal conduction and the myelination of the peripheral nervous system, related with the age and height of the child. The most affected parameters results to be the Latency of the Motor Evoked Potential (L-MEP) and the Central Motor Conduction Time (CMCT). Both parameters are stable during the childhood growing progressively with the age and height. This study demonstrated how the motor conduction is closely related to the age and height of the child and, consequently, to the degrees of maturation of the nervous fibers, and how the CMCT and L-MEP are affected by the maturation of the peripheral nerves. In addition this work also emphasizes the importance of knowing the normative data of MEP in all ranges of ages to better identify the pathological findings in child’s nervous system injury.

Chorioamnionitis and cerebral palsy: Lessons from a patient registry

AimThe fetal neuroinflammatory response has been linked to the development of brain injury in newborns and subsequent neurologic impairment. We aimed to explore the maternal and child factors associated with histologic chorioamnionitis in cerebral palsy. MethodsWe conducted an observational study on a cohort of children with cerebral palsy who were identified from the Quebec Cerebral Palsy Registry. Placental pathology was reported prospectively. Maternal and child factors associated with histological chorioamnionitis were explored. ResultsPlacental reports were available in 455 of 534 (85%) children with cerebral palsy, and of these 12% had histological signs of chorioamnionitis on reports. These children were more likely to have large placentas over 90th percentile for gestational age (53.7% versus 30.7%, p = 0.001) and were born significantly more prematurely (<32 weeks in 51.9% vs 24.1%, p = 0.007) than children without chorioamnionitis. A clinical sign of perinatal infection was reported in 61.1% of children with chorioamnionitis, however each clinical sign was seen in a minority of these children. Children with chorioamnionitis were more likely to have spastic diplegic cerebral palsy subtype (37% vs 19.2%, p = 0.003) and periventricular white matter injury on neuroimaging (52.9% vs 35.8%, p = 0.004). However no differences in neuroimaging or subtypes were seen when stratified by prematurity. DiscussionHistological chorioamnionitis was a frequent pathological finding in children with cerebral palsy born prematurely, with larger placentas relative to gestation and birth weight. Future case control studies are needed to shed light on the role of inflammatory placental findings in pregnancy outcomes.

Association among Histopathology, Clinical Manifestation, and Ultrasonographic Grades in Pediatric Non-alcoholic Fatty Liver Disease

Nonalcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD), and its prevalence is increasing worldwide. Liver biopsy remains the best way to diagnose NASH and establish the presence of fibrosis, but has not been performed easily in children because of its invasiveness. We analyzed the ultrasonographic and histopathologic findings of pediatric NAFLD patients, and studied to find their association with clinical characteristics and laboratory findings. The study involved 18 obese children ranging from 7 to 15 years of age, who were diagnosed with NASH by liver biopsy. We performed the abdomen ultrasonography before the liver biopsy. We reviewed their pathology slides and classified them by NASH CRN (Clinical Research Network) scoring system. We also reviewed the abdomen ultrasonographic findings of the patients and classified them into grade of 1, 2, and 3. We reviewed the medical records of the patients and investigated their clinical characteristics and laboratory findings. The ultrasonographic grades had significant association with NAFLD activity score, grade of steatosis amount, ballooning change, and portal inflammation. Serum triglyceride level was significantly higher in patients who showed high grade steatosis and high NAFLD activity score. This study showed that serum triglycerides and ultrasonographic findings are highly correlated with pathologic findings in children with NAFLD.

Abnormal Gastrointestinal Histopathology in Children With Autism Spectrum Disorders.

OBJECTIVES:: The significance of the association between many gastrointestinal (GI) pathologies and autism has yet to be discovered. The aim of the present study was to review available evidence documenting any link between autism and GI histopathology in children. MATERIALS AND METHODS:: In a systematic review, the following sources were searched: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1980-August week 2, 2009), EMBASE (1980-August week 2, 2009), PubMed (last 180 days), Web of Science, and Scopus, using the terms "autism" or "autistic spectrum disorder" and "intestinal" or "gastrointestinal" or "colitis." In addition, relevant studies were identified through browsing the reference lists of the included articles for relevant citations. All children younger than 18 years old with autistic spectrum disorder who were examined for abnormal GI histopathology were included. Cohort studies published in the English language, reporting GI histopathological examination findings in children with autism, were included. Two independent authors performed data extraction. The methodological quality of each trial was assessed. RESULTS:: Eight studies have reported the histopathological features of the GI tract in children with autism and fulfilled inclusion criteria. In general, none of these trials appeared to be of high quality. Apart from intestinal lymphonodular hyperplasia, the majority of these findings were not consistent. CONCLUSIONS:: GI pathological findings in children with autism have been inconsistent. The present available evidence does not support or refute a link between GI histopathology and autism in children. The significance of intestinal lymphonodular hyperplasia in these children is unknown. Large properly designed prospective controlled trials addressing this issue are required.

Double Thyroglossal Duct Cyst Derived from a Single Tract: A Rare Presentation

Introduction: Thyroglossal duct cysts are one of the most common congenital pathologic findings in children's cervical area. This type of cyst can be located anywhere between the base of the tongue and the sternal manubrium. Case Report: We report the case of a patient with a double thyroglossal cyst, located inferior to the hyoid bone. The 2 cysts were connected by a common permeable tract, which confirms that an evolution failure of the embryonic remnants of the thyroglossal duct has been responsible for the development of such a cyst. Our case is the second case of double thyroglossal duct cysts and the first of double cysts located in the neck outside the thyroid gland.

Double cervical cyst derived from a single thyroglossal duct tract

Thyroglossal duct cysts are one of the most common congenital cervical pathologic findings in children. This type of cyst can be located anywhere between the base of the tongue and the sternal manubrium. We report the case of a patient with a double thyroglossal cyst, one located in the hyoid region and the other in the thyroid gland. The 2 cysts were connected by a permeable tract, which confirms that an involution failure of the embryonic remains of the thyroglossal duct was responsible for the development of the cyst. Intrathyroid cysts of the thyroglossal duct, though uncommon, should be included in the differential diagnosis of thyroid cysts in children.

934 P2X 3 RECEPTOR-EXPRESSION IN FETAL AND INFANT BLADDERS - THE BASIS FOR A NEW THERAPEUTIC CONCEPT FOR OVERACTIVE BLADDERS IN CHILDREN

Introduction. The urothelium plays an active role in the regulation of urinary bladder function due to its sensorial properties. P2X3 receptors are critical components of this sensory pathway. They convey afferent information creating central nervous pain perception. We report the expressional time course of P2X3-receptors from fetal life to adulthood to rule out their possible implications in various bladder pathologies. Material and methods. Fetal, neonatal, and adult bladder specimens were obtained and immunostained with anti-P2X3 antibodies. A computer assisted microscope evaluated the intensity, extension, and tissue distribution. results. P2X3-receptors are widely abundant in the suburothelial space containing the nerve plexuses. These suburothelial nerve fibers expressing P2X3 were demonstrated in fetal as well as infant bladder tissue. However, the overall P2X3 expression was less intense in fetuses when compared to infants. In contrast to previously described adult specimens, we found a higher density of P2X3 receptors in infants and fetuses. Conclusions. This is the first study investigating the expressional time course of P2X3 receptors during human fetal development as well as in infancy. The disproportionately strong expression of P2X3-receptors in infants may explain the process of reflective bladder emptying in non-toilet trained children. However, P2X3 is less abundant in adults with a normal voiding pattern. Correspondingly, overexpression or deregulation of the P2X3 receptor complex may explain the lack of significant pathological findings in children with overactive bladder. Nonetheless, the inconsistent expression of P2X3 receptors in fetuses and infants may permit new therapeutic concepts.

Nodular Gastritis and Pathologic Findings in Children and Young Adults with Helicobacter pylori Infection

PurposeThe aim of this study was to investigate the pathologic characteristics of nodular gastritis in children and young adults infected with Helicobacter pylori (H. pylori).Materials and MethodsA total of 328 patients were enrolled in this study, and the diagnosis of H. pylori infection was done with gastroduodenal endoscopy concomitant with a CLO™ test and pathologic analysis of the biopsy specimens. Diagnoses of normal, superficial gastritis, nodular gastritis, and peptic ulcer disease were made from the gastroduodenal endoscopic findings. The density of H. pylori organisms in the gastric mucosa was rated as normal, mild, moderate, or marked. The pathologic findings of nodular gastritis were based on the histopathologic findings of inflammation, immune activity, glandular atrophy and intestinal metaplasia. Each of these findings was scored as either normal (0), mild (1), moderate (2), or marked (3) according to the updated Sydney system and using visual analog scales. The gastritis score was the sum of the four histopathologic scores.ResultsIn this study, nodular gastritis (50.6%) was most common, and mild density (51.5%) H. pylori infection was also common upon microscopic examination. Intestinal metaplasia occurred in 9 patients (2.7%).ConclusionLogistic regression revealed a significant increase in the incidence of nodular gastritis with gastritis score (p = 0.008), but not an association with sex, age, or H. pylori density. Gastritis score was the only significant factor influencing the occurrence of nodular gastritis. Intestinal metaplasia, which was originally thought to be a pre-malignant lesion, occurred in 2.7% of the patients with H. pylori infection.

Congenital Solitary Liver Cysts

The aim of the study was to describe clinical and pathological findings in children with rare congenital solitary liver cyst. Six children with congenital liver cyst were treated at the authors' institution from 1995 to 2002. Clinical records and operative findings of these patients were reviewed retrospectively. Age at presentation ranged from neonatal to 14 years, and there were four girls and two boys. Hepatomegaly was the most common symptom in neonates while the older children presented with abdominal pain. Ultrasound was conclusive for diagnosis in all children, prenatal ultrasound in three. Intrahepatic cyst was found in five children. Partially extrahepatic cyst in the porta hepatis was found in one. The cyst diameters varied from 8 to 10 cm. Cysts were excised via an open abdominal approach in all patients. Histological findings confirmed the diagnosis of congenital liver cyst. Columnar epithelium was found in newborns while atrophic changes of epithelial lining were seen in older children. In a case of a 13-year-old girl the cyst was lined by metaplastic squamous epithelium with foci of slight dysplasia. Immunohistochemical studies were available in three recent children with positive findings in all of them. The postoperative course was uneventful in all patients. The follow-up period ranged from 36-120 months and no recurrence was observed. With appropriate selection of symptomatic patients, total excision of a congenital liver cyst is a safe procedure with excellent long-term results. Given the possibility of malignant degeneration of a congenital liver cyst we recommend its surgical excision in most cases.

Radiological–pathological correlation in lipoblastoma and lipoblastomatosis

Lipoblastoma and lipoblastomatosis are uncommon benign mesenchymal lesions that predominantly occur in infancy and early childhood. To evaluate the imaging and histological features of lipoblastoma and lipoblastomatosis. Retrospective review of the radiological and pathological findings in children with lipoblastoma and lipoblastomatosis treated at a single centre between 1997 and 2004. Eight children (median age 18 months) had undergone imaging and surgery at our institution. An infiltrative growth pattern was identified at imaging in two children with lipoblastomatosis, and a well-defined mass in six children with lipoblastoma. In all patients, imaging showed a lesion composed mostly, but not entirely, of fat. There were no recurrences at follow-up of between 1 and 91 months. In infancy and early childhood, the identification of a tumour composed mostly of fat should suggest the diagnosis of lipoblastoma or lipoblastomatosis.

The significance of ileo-colonic lymphoid nodular hyperplasia in children with autistic spectrum disorder

Intestinal mucosal pathology, characterized by ileo-colonic lymphoid nodular hyperplasia (LNH) and mild acute and chronic inflammation of the colorectum, small bowel and stomach, has been reported in children with autistic spectrum disorder (ASD). To assess ileo-colonic LNH in ASD and control children and to test the hypothesis that there is an association between ileo-colonic LNH and ASD in children. One hundred and forty-eight consecutive children with ASD (median age 6 years; range 2-16; 127 male) with gastrointestinal symptoms were investigated by ileo-colonoscopy. Macroscopic and histological features were scored and compared with 30 developmentally normal (non-inflammatory bowel disease, non-coeliac disease) controls (median age 7 years; range 1-11; 25 male) showing mild non-specific colitis in 16 cases (13 male) and normal colonic histology in 14 cases (12 male). Seventy-four ASD children and 23 controls also underwent upper gastrointestinal endoscopy. The influence on ileal LNH of dietary restriction, age at colonoscopy, and co-existent LNH elsewhere in the intestine, was examined. The prevalence of LNH was significantly greater in ASD children compared with controls in the ileum (129/144 (90%) vs. 8/27 (30%), P < 0.0001) and colon (88/148 (59%) vs. 7/30 (23%), P = 0.0003), whether or not controls had co-existent colonic inflammation. The severity of ileal LNH was significantly greater in ASD children compared with controls, with moderate to severe ileal LNH present in 98 of 144 (68%) ASD children versus 4 of 27 (15%) controls (P < 0.0001). Severe ileal LNH was associated with co-existent colonic LNH in ASD children (P = 0.01). The presence and severity of ileal LNH was not influenced by either diet or age at colonoscopy (P = 0.2). Isolated ileal LNH without evidence of pathology elsewhere in the intestine was a rare event, occurring in less than 3% of children overall. On histopathological examination, hyperplastic lymphoid follicles are significantly more prevalent in the ileum of ASD children (84/138; 61%) compared with controls (2/23; 9%, P = 0.0001). Ileo-colonic LNH is a characteristic pathological finding in children with ASD and gastrointestinal symptoms, and is associated with mucosal inflammation. Differences in age at colonoscopy and diet do not account for these changes. The data support the hypothesis that LNH is a significant pathological finding in ASD children.

DISSEMINATED CALCIFICATION WITH PREDOMINANT MUSCLE AND CEREBRAL INVOLVEMENT IN A CHILD WITH ACQUIRED IMMUNODEFICIENCY SYNDROME: A Case Report

Calcification, as a feature of the vasculopathy, is a common pathological finding in children with acquired immunodeficiency syndrome. Large and small blood vessels of many organs including brain, heart, lungs, kidneys, liver, and spleen are affected. We report a case with calcification in multiple organs that was most prominent in the cardiac and skeletal muscle cells and the blood vessels of the cerebrum. To our knowledge, calcification of this degree has not been documented previously in a human immunodeficiency virus-infected child.