Soft Tissue Lesions In Children Research Articles

Mucocele in Pediatric: A case report

Introduction: Mucocele is a lesion on the oral mucosa as a benign mass caused by retention or extravasation of mucus in the tissue around the lamina propria. Mucocele mainly occurs on the lower lip mucosa. Purpose: This case report aimed to describe the history, clinical examination, and simple surgical removal of mucocele, thus it can strengthen the knowledge of the general dental practitioner. Case presentation: A 6-year-old female child visited the Dental and Oral Hospital of South Sumatera Province with complaints of swelling on the right inner lower lip about 2 weeks ago. The swelling disappeared because it ruptured due to being bitten 2 months ago, then reappeared in the last 2 weeks. Her mother also said that her child had unconsciously bit her lower lip almost every day for the last few months. The results of an objective examination of the lesion showed a fluctuating vesicle lesion on the labial mucosa of the right lower lip, approximately 5 mm in diameter, did not bleed easily, was soft and painless upon palpation, had a translucent bluish-pink color. Based on the results of subjective, objective, and supporting examinations, the diagnosis in this case was a mucocele with a differential diagnosis of fibroma and hemangioma. The treatment plan included surgical excision and post-surgery instructions as well as instructions to stop the bad habits to prevent the recurrences. Conclusion: Mucocele is one of the most common soft tissue lesions in children and it can be treated with simple surgical excision.

Oral Soft Tissue Lesions in Children

Lips, teeth, gums, oral mucous membranes, palate, tongue, and the oral lymphoid system comprise the oral cavity. Oral cavity soft tissue lesions are extremely common in children, and they can present clinically as coloured lesions, mucosal ulceration, or Nodular lesions. The appearance of the oral mucosa alters to reflect the underlying health status, which could be local or systemic. While most oral diseases can be diagnosed visually, some disorders can be befuddling, and their diagnoses can be elusive. Pigmentation is defined as the process of pigment deposition in tissues. This article provides a brief overview of oral pigmented lesions in children Keywords: oral soft tissue lesions, mucosal abnormalities, children, paediatric dentistry

Expanding Our Knowledge of Molecular Pathogenesis in Histiocytoses: Solitary Soft Tissue Histiocytomas in Children With a Novel CLTC::SYK Fusion.

The histiocytoses comprise a histopathologically and clinically diverse group of disorders bearing recurrent genomic alterations, commonly involving the BRAF gene and mitogen-activated protein kinase pathway. In the current study, a novel CLTC :: SYK fusion in 3 cases of a histopathologically distinct histiocytic neoplasm arising as solitary soft tissue lesions in children identified by next-generation sequencing and fluorescence in situ hybridization is described. Morphologically, all 3 neoplasms were composed of sheets of cells with round-oval nuclei and vacuolated eosinophilic cytoplasm but, in contrast to classic juvenile xanthogranuloma (JXG), Touton giant cells were absent. A separate cohort of classic JXG cases subsequently profiled by fluorescence in situ hybridization were negative for the presence of a CLTC::SYK fusion suggesting that CLTC::SYK fusion-positive histiocytoma is genetically and histologically distinct from JXG. We postulate that the CLTC::SYK fusion leads to aberrant activation of the SYK kinase, which is involved in variable pathways, including mitogen-activated protein kinase. The identification of a novel CLTC::SYK fusion may pave the way for the development of targeted therapeutic options for aggressive disease.

Ultrasonography of Pediatric Superficial Soft Tissue Tumors and Tumor-Like Lesions.

Ultrasonography (US) is usually the first imaging examination performed to evaluate palpable or visible superficial soft tissue lesions that are common in children. Although clinical assessments, such as age at presentation, clinical course, and overlying skin discoloration, are important for the differentiation of pediatric soft tissue lesions, US allows a specific diagnosis of some typical benign lesions and helps in guiding further investigation since it provides detailed information about the lesion location, characterization including solid versus cystic, vascularity, and compressibility. Therefore, sufficient knowledge of the normal anatomy, proper ultrasonographic techniques, and the imaging findings of common and uncommon soft tissue lesions in children are crucial for accurate assessment and management of patients. In this article, we review the techniques and imaging findings focusing on the ultrasonographic features of a variety of superficial soft tissue lesions detected in children.

Up-to-date imaging review of paediatric soft tissue vascular masses, focusing on sonography.

The purpose of this article is to provide an up-to-date overview on imaging of paediatric vascular soft tissue masses, including both neoplastic and non-neoplastic lesions. We describe the-often challenging-imaging diagnosis-mainly performed by ultrasound (and secondarily by MRI) and differential diagnosis of vascular soft tissue lesions in children. We underline how important it is to determine whether a vascular anomaly has a regional vascular origin, or if there are other entities, ranging from benign to malignant lesions, which have flow-signal or blood degradation products. Even though clinical examination and patient's history are the first and indispensable steps in the initial diagnosis, the role of imaging is crucial, not only to determine whether a mass represents a true tumour/pseudo-tumour, but also to achieve a more correct diagnosis and determine the extension of the tumour/pseudo-tumour and its relation with the nearby anatomic structures.

Characterizing pilomatricomas in children: a single institution experience

Background/PurposePilomatricomas, or calcifying epitheliomas of Malherbe, are among the most common superficial cutaneous soft tissue lesions in children. Familiarity with the presenting signs and symptoms allows for the diagnosis to be made on physical examination alone in most patients, avoiding expensive and unnecessary diagnostic imaging. MethodsA retrospective IRB-approved review of surgical pathology archives and medical records of all patients undergoing excision of pilomatricomas between 1982 and 2010 was performed to determine the characteristics of the pilomatricoma tumors. Data regarding gender, age, location, size of tumor, and histopathology were collected. ResultsThere were 916 pilomatricomas resected in 802 patients. Fifty-five percent of the patients were girls (441 patients). The median age at the time of resection was 6years (range 5months to 18years). Multiple lesions were found in 43 patients (5%). The most common location was head and neck (n=529, 58%), followed by upper limbs (n=214, 23%), trunk (n=130, 14%), and lower limbs (n=43, 5%). Information on size was available for 674 lesions; mean lesion diameter was 14.0 ±7.4mm. Twenty-eight patients (3%) had either recurrent (n=11) or metachronous (n=17) lesions resected at our institution, with a median interval of 12months after initial resection (range 5weeks to 5years). No cases of pilomatrix carcinoma were observed. ConclusionThe majority of pilomatricomas occur in the head and neck, although they can present in any location. Approximately 5% of children have multiple lesions. Pilomatricomas occur slightly more commonly in girls, and 66% of lesions occur in children <10years of age. Complete surgical excision is necessary to prevent recurrence. Recurrences and pilomatrix carcinoma are very rare if complete excision is achieved.

Hyperbaric oxygen treatment of superficial soft tissue lesions in children with oncologic disease

This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5–16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill.

Melanotic Neuroectodermal Tumor of Infancy Presenting in the Subcutaneous Soft Tissue of the Thigh

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare and diagnostically challenging neoplasm typically presenting in the bones of the maxilla, skull, or mandible. Only 6 of approximately 357 reported cases have involved the subcutis. We describe a case of MNTI presenting as a palpable, subcutaneous, thigh mass in a 5-month-old girl. By ultrasound, the mass was round with well-defined borders, minimal vascularity, and heterogeneous echogenicity. Microscopically, the tumor consisted of nested foci of primitive-appearing small round blue cells with an increased nuclear to cytoplasmic ratio, stippled chromatin, and occasional mitotic figures. A larger and more epithelioid second cell population exhibited eosinophilic cytoplasm and sparse pigmented granules. The background stroma was fibrous and densely sclerotic. The differential diagnosis of soft tissue MNTI can include melanoma, neuroblastoma, rhabdomyosarcoma, desmoplastic small round cell tumor, and other pediatric "small round cell" neoplasms. The tumor had the characteristic immunophenotype of MNTI: cytokeratin+, HMB-45+, neuron-specific enolase+, and synaptophysin+. MNTI should be considered in the differential diagnosis of pigmented soft tissue lesions in children. Our patient remains disease-free 40 months after excision, although these tumors can locally recur (10%-20%) and rarely metastasize.

Imaging and diagnostic strategy of soft tissue tumors in children

The diagnosis of a soft tissue mass in children is a common clinical situation. Most of the lesions are benign and can be treated conservatively or by non-mutilating surgery. Nevertheless, the possibility of a malignant soft tissue tumor must be systematically considered. The most frequent benign soft tissue lesions in children are vascular lesions, fibrous and fibrohistiocytic tumors and pseudotumors, whereas rhabdomyosarcomas account for 50% of all soft tissue sarcomas. A child presenting an atypical soft tissue mass should be managed by a multidisciplinary centre, and primary resection must be proscribed until a definite diagnosis has been established. The role of imaging is essential either to confirm the benign nature of the mass or to give arguments to perform a diagnostic biopsy. Clinical examination, conventional radiography and ultrasound with Doppler represent the first-line examinations and are sometimes sufficient to assess a diagnosis. In all other situations, MRI is mandatory to establish the probable nature of the lesion and to assess local extension.

Magnetic resonance imaging of congenital, inflammatory, and infectious soft-tissue lesions in children.

Magnetic resonance imaging has the advantages of multiplanar capability and high degree of tissue differentiation. It is useful for assessing the extent of soft-tissue abnormalities, such as vascular malformations, inflammatory and infectious processes, muscle disorders, and limb hypertrophy. Magnetic resonance imaging is sensitive to the presence of water and edema and is a good indicator for early diagnosis of inflammation and its level of activity. Fat-saturation techniques, including T2-weighted sequences and inversion recovery imaging, optimize diagnostic accuracy. T1-weighted images are good at defining the distribution and proportion of fat in the body, so they are useful in evaluating syndromes of the limbs, including vascular malformations, as well as lipoatrophy-lipodystrophy conditions. Magnetic resonance imaging provides guidance for efficient tissue biopsy. It allows comprehensive pretherapeutic assessment of soft-tissue vascular anomalies. It constitutes a good modality for following up the natural history of soft-tissue disorders during childhood.

Fat necrosis after trauma: a benign cause of palpable lumps in children.

Our objective is to describe the clinical entity and MR imaging appearance of fat necrosis after trauma, a benign cause of palpable soft-tissue lesions in children. A related objective is to establish MR imaging criteria that can be used reliably to differentiate this entity from other more serious causes of soft-tissue masses. Fat necrosis after trauma is a common cause of palpable lumps in children and has a benign course on long-term follow-up. When characteristic MR imaging findings are seen, conservative therapy is appropriate.

MRI evaluation of superficial soft tissue lesions in children.

The role of MRI in the evaluation of superficial soft tissue lesions in children has not been well established. We present our experience with MRI in the evaluation of nineteen children with a variety of cutaneous and subcutaneous lesions. We find MRI to have a definite role in the evaluation of these lesions particularly when determining extent or depth of involvement would affect medical or surgical management. MRI has a less well defined role in tissue determination. Spin echo T1 and T2 weighted images were sufficient for evaluation in most cases. Fat suppression images added additional information in fatty tumors. The MRI appearance of juvenile hyaline fibromatosis and lipoblastomatosis has not been previously described and is included in this study.