Rare benign tumor in a prepubescent accessory breast: a case report

Background

Polymastia or accessory breast is a congenital condition seen in 1% of the population at birth and in 2–6% of the female population. The most common presentation is in the pubertal age group when secondary sexual characters begin to develop or during pregnancy and lactation. Giant cell fibroblastoma is an exceedingly rare benign soft tissue neoplasm in the pediatric age group, usually seen over the back and thigh. We report a case of giant cell fibroblastoma in accessory breast tissue in a 4-year-old, female child. This case is rare in its presentation at the age of 4 years with an enlarging accessory breast without any secondary sexual characters. Giant cell fibroblastoma in the accessory breast tissue is unreported yet.

Case presentation

A 4-year-old female child presented with a progressively enlarging accessory breast. A wide local excision of the accessory breast with underlying growth was done. The histopathological examination revealed a giant cell fibroblastoma within the breast tissue.

Conclusions

Enlargement of an accessory or normal breast at a prepubescent age with the absence of secondary sexual characters should arouse suspicion of benign tumors in the breast tissue.

Efficacy of fibrin sealant as waterproof cover in improving outcome in hypospadias surgery

BACKGROUND

This prospective comparative study aims to assess the efficacy of fibrin sealant to improve outcomes in paediatric patients operated for hypospadias.

MATERIALS AND METHODS

Forty consecutive patients with hypospadias were randomised into two groups of twenty patients each. The first group underwent hypospadias repair, technique depending on the type of hypospadias, whereas in the second group, fibrin sealant was used to reinforce the urethroplasty. Assessment was done with respect to the type of hypospadias, type of repair done, operative time, immediate post-operative complications (early ooze and skin flap-related complications), intermediate complications (urethra-cutaneous fistula) and delayed post-operative complications (penile torsion and poor cosmetic outcome) at follow-up. We also compared the overall improvement in outcome among the two groups.

RESULTS

First Group: The mean operative time was 1 h and 45 min. Complications were seen in nine patients: Early ooze (n = 2); skin flap-related complications (n = 3); fistula (n = 7); poor cosmetic outcome (n = 7) and penile torsion (n = 4). Second Group (Fibrin Sealant): The mean operative time was 1 h and 30 min. Post-operative complications were observed in five patients: Coronal fistula (n = 3) and poor cosmetic outcome (n = 3). On comparing, the differences in outcomes of ooze, skin flap-related complications and torsion were found to be statistically significant with P < 0.05. The differences in the urethra-cutaneous fistula and cosmetic appearance were not found to be statistically significant. The difference in overall improvement in complications was found to be statistically significant.

CONCLUSION

Fibrin sealant, when applied over the urethroplasty suture line as a waterproof cover, may help to improve the outcome in patients with hypospadias.

Transurethral incision of ureteroceles in paediatric age group

OBJECTIVE

Ureteroceles are a great clinical challenge because of variations in anatomy and clinical presentations. We present our experience with primary transurethral incision of ureteroceles in children.

MATERIAL AND METHODS

Data of thirteen children managed for ureterocele from 2009 to 2016 was retrospectively analyzed with respect to age, sex, clinical presentation and symptomatology, type and localization of ureterocele, investigations, surgical management and follow-up.

RESULTS

A total of 13 patients with ureteroceles were managed. There were 7 males and 6 females. Six were neonates with antenatal diagnosis of ureteroceles. Five patients presented with urinary tract infection and two were diagnosed during ultrasound for abdominal pain. The ureteroceles were on the right side in 7 patients and left in 6 patients. Six patients had a duplex system-five on right side and bilateral in one. Two patients had ureteroceles in solitary kidney. Four patients had associated hydronephrosis and hydroureter and two had only hydronephrosis alone. One patient had bilateral grade III reflux in the bilateral lower moieties of the patient with bilateral duplex system. Two patients had poorly functioning kidney on radionuclide scan. All patients underwent cystoscopic incision of the ureteroceles. Eleven had intravesical ureteroceles and two had large caeco-ureteroceles. Two patients required ureteric reimplantation during follow-up.

CONCLUSION

Though the approach of managing a patient with ureterocele should be individualized, transurethral incision remains valuable as a primary intervention with regular follow up. It may even prove to be the only intervention required in most of the patients.

Ovarian yolk sac tumour in a girl - case report

Yolk sac tumours are rare ovarian malignancies accounting for less than 1% of malignant ovarian germ cell tumours. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumour. We describe stage III yolk sac tumour in a girl child.