Evaluation of Children and Adolescents with Thyroid Nodules: A Single Center Experience

OBJECTIVE

We aimed to evaluate the clinical, radiological and pathological findings of children and adolescents with thyroid nodules.

METHODS

Data of 121 children and adolescent with thyroid nodules and had fine needle aspiration (FNA) were examined retrospectively. Concomitant thyroid disease, ultrasonography (US) features of the nodule, FNA and histopathological results were recorded. FNA results were assessed according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).

RESULTS

Median (range) age of the cases was 14 (3-18) years and 81% were female. FNA results of patients were: insufficient in 1 (0.8%); benign in 68 (56.2%); indeterminate in 44 (36.4%); and malignant in 8 (6.6%) patients. Among 39 patients who underwent surgery, 10 (25.6%) had differentiated thyroid cancer (DTC) and the overall malignancy rate was 10.0% (10/100). Follow-up FNA results showed progress based on TBSRTC in 18.7% of benign results and 4/75 patients had DTC on surgical excision. Two of 22 patients with atypia of undetermined significance (AUS) who continued follow-up was diagnosed with DTC. Male gender, presence of Hashimoto thyroiditis and US findings of uninodularity, hypoechogenicity, increased blood flow, irregular margins, solid structure, microcalcification and presence of abnormal cervical lymph nodes were associated with malignancy.

CONCLUSION

In this study 10% of thyroid nodules were malignant in children and adolescents. Patients with AUS have a 9% potential for malignancy. Patients with initially benign FNA result may have changes on repeat FNA when assessed with TBSTRC indicating a 5.3% false negative rate.

Retrospective Evaluation Of Pediatric Patients With Abdominal Tuberculosis: A Single Center Experience

Objective: Abdominal tuberculosis is a kind of extrapulmonary tuberculosis that can usually occur during the lymphohematogenous spread of first Mycobacterium tuberculosis infection, develop by neighborhood from an abdominal focus or a mesenteric lymph node. The aim of this study is to evaluate pediatric cases diagnosed with abdominal tuberculosis. Material and Methods: Between 2012-2018, seven patients diagnosed with abdominal tuberculosis through patients who diagnosed with extrapulmonary tuberculosis in our hospital, were included in study. Demographic and clinical characteristics, diagnostic methods, commenced treatments and clinical follow up of patients were listed from medical records. Results: Of patients, four were female. The mean age was 144.2 ± 42.7 months. None of the patients had a history of tuberculosis contact. The median complaint time was 20 days (5-180). The most frequent complaint was abdominal pain and the most frequent physical examination finding was abdominal tenderness. Mean white blood cell count was 9.26 x 103 ± 4.77 x 103 μ/L, C reactive protein level: 79.9 ± 54.9 mg/dL, erytrocyte sedimentation rate: 45 ± 30 mm/h. Tuberculin skin test was positive in two patients, interferon gamma releasing assay was positive in three patients, and in two patients, both tests were positive. There were findings suggesting tuberculosis on pulmonary imaging in five patients and abdominal imaging in all patients. Histopathological examination of the specimens of six patients revealed findings consistent with tuberculosis. The presence of M. tuberculosis was confirmed microbiologically in clinical specimens taken from three patients. The most common abdominal tuberculosis type was mesenteric lymphadenitis. The mean time from admission to diagnosis was 15 ± 12.8 days. All patients recieved antituberculosis treatment. Conclusion: Abdominal tuberculosis should be kept in mind, in patients presenting with abdominal complaints lasting more than five days. Ultrasonography and computed tomography are useful to determine abdominal tuberculosis type. The disease can be sucsessfully treated with standart antituberculosis treatment.

Retrospective Evaluation of Pediatric Patients With Abdominal Tuberculosis: A Single Center Experience

Objective: Abdominal tuberculosis is a kind of extrapulmonary tuberculosis that can usually occur during the lymphohematogenous spread of first Mycobacterium tuberculosis infection, develop by neighborhood from an abdominal focus or a mesenteric lymph node. The aim of this study is to evaluate pediatric cases diagnosed with abdominal tuberculosis. Material and Methods: Between 2012-2018, seven patients diagnosed with abdominal tuberculosis through patients who diagnosed with extrapulmonary tuberculosis in our hospital, were included in study. Demographic and clinical characteristics, diagnostic methods, commenced treatments and clinical follow up of patients were listed from medical records. Results: Of patients, four were female. The mean age was 144.2 ± 42.7 months. None of the patients had a history of tuberculosis contact. The median complaint time was 20 days (5-180). The most frequent complaint was abdominal pain and the most frequent physical examination finding was abdominal tenderness. Mean white blood cell count was 9.26 x 103 ± 4.77 x 103 μ/L, C reactive protein level: 79.9 ± 54.9 mg/dL, erytrocyte sedimentation rate: 45 ± 30 mm/h. Tuberculin skin test was positive in two patients, interferon gamma releasing assay was positive in three patients, and in two patients, both tests were positive. There were findings suggesting tuberculosis on pulmonary imaging in five patients and abdominal imaging in all patients. Histopathological examination of the specimens of six patients revealed findings consistent with tuberculosis. The presence of M. tuberculosis was confirmed microbiologically in clinical specimens taken from three patients. The most common abdominal tuberculosis type was mesenteric lymphadenitis. The mean time from admission to diagnosis was 15 ± 12.8 days. All patients recieved antituberculosis treatment. Conclusion: Abdominal tuberculosis should be kept in mind, in patients presenting with abdominal complaints lasting more than five days. Ultrasonography and computed tomography are useful to determine abdominal tuberculosis type. The disease can be sucsessfully treated with standart antituberculosis treatment.

Clinicopathological Assessment of Kidney Biopsies in Children with Familial Mediterranean Fever: A Single-Center Experience

OBJECTIVES

Familial Mediterranean fever (FMF) is a monogenic auto-inflammatory disease which might rarely cause glomerulopathy in patients. The aim of this study was to determine the clinical, demographic, and genetic characteristics and type of glomerular lesions in pediatric FMF patients who underwent kidney biopsy.

METHODS

The data of 30 pediatric FMF patients with biopsy-proven glomerulopathy were retrospectively reviewed. Patients were grouped into 2 categories as amyloid nephropathy (AN, n = 16) and non-amyloid nephropathy (N-AN, n = 14).

RESULTS

The mean age at FMF diagnosis was 7.2 ± 3.0 years. The AN group showed higher rates of hypertension, higher levels of 24-h protein excretion and serum creatinine, and lower estimated glomerular filtration rate at the time of kidney biopsy. The rate of ESRD was found to be higher in the AN group (p = 0.011). Mesangioproliferative glomerulonephritis was the most common pathology in the N-AN group (21.4%). The frequency of amyloidosis was significantly higher in patients with homozygous p.M694V mutations than non-homozygous p.M694V mutations (p = 0.039).

CONCLUSIONS

In children with FMF, nephropathy is rare. To our knowledge, this is the first study performed in pediatric FMF patients exploring amyloid and non-amyloid glomerulopathies. Patients with AN had higher rates of proteinuria, lower estimated glomerular filtration rate levels, and higher blood pressure than N-AN patients at the time of biopsy.

Symptomatic Fetal-Type Cardiac Rhabdomyoma

Rhabdomyomas are the most common primary cardiac tumors, especially seen during early periods of childhood. Fetaltype rhabdomyoma is a benign tumor described almost always in extracardiac locations. Although the natural history of the cardiac rhabdomyoma is to regress, the behaviour of the fetal-type rhabdomyomas when present in the heart is unknown with respect to its infrequency. Herein, we report a hemodynamically unstable female neonate with a single large intra-cardiac mass unresponsive to medical treatment, who underwent surgery. The neonate could not survive the operation due to ventricular fibrillation. The mass was diagnosed as fetal-type cardiac rhabdomyoma on autopsy.

Crescentic glomerulonephritis in children: a single centre experience

BACKGROUND

Crescentic glomerulonephritis (CsGN) is characterized by crescents in 50% or more of glomeruli and clinically by a sudden and progressive decline in renal function.

METHODS

We evaluated the etiology, clinical features, prognostic factors and long-term outcome of CsGN. Between January 2000 and December 2010, 45 children (26 girls, 19 boys) with biopsy-proven CsGN (>50% crescents) were investigated retrospectively.

RESULTS

The mean age of the patients was 130.86±33.77 months. The mean duration of symptoms prior to diagnosis was 26±12 days (4-40 days). Most of the children had hypertension (62.2%), macroscopic hematuria (73.3%), oligoanuria (44.4%), edema (51.1%) and purpuric rash (40%) at presentation. The final clinical status of the patients was complete remission (n=21), partial remission (n=5) or chronic kidney disease (n=19). Adverse outcomes were significantly associated with a long duration between the onset of symptoms and treatment (P=0.038), the presence of oligoanuria (P=0.006), a severe decreased glomerular filtration rate (GFR <30 mL/min/1.73m²) and the need for dialysis (P=0.003) on admission, the ratio of crescents (>75%) (P=0.03), and the ratio of fibrous crescents (P=0.015).

CONCLUSION

The outcome of CsGN in children continues to be poor, and it should be treated as a renal emergency.

Childhood fibroblastic and myofibroblastic tumors: a multicenter documentation and review of the literature

OBJECTIVE

In this study, we aimed to give a documentation of 37 cases of childhood fibroblastic/myofibroblastic tumors retrieved from the archives of 6 reference centers in Ankara along with a comprehensive review on the subject.

MATERIAL AND METHOD

A retrospective archive search was carried out for the period between 2006-2010 in 6 reference centers in Ankara covering patients with ages ranging between 0-18 years. All the tumors categorized under fibroblastic and myofibroblastic group according to World Health Organization criteria were collected.

RESULTS

The study comprised 407 soft tissue tumors in total. Fibroblastic/myofibroblastic tumors constituted 9,1 % (37 cases) of these tumors. According to histopathology; 16 cases were categorized as fibromatosis, 8 cases as inflammatory myofibroblastic tumor, 6 cases as infantile fibrous hamartoma, 3 cases as nodular fasciitis and 2 cases as infantile myofibroblastic tumor/myofibromatosis and 1 case as cranial fasciitis. The only malignant case was an infantile fibrosarcoma.

CONCLUSION

Infantile fibrosarcoma was lower than reported series and a male predominance was noted. The low incidence of newly described entities as well suggests that these tumors may have been unrecognized.

Thyroid nodules in children and adolescents: a single institution's experience

OBJECTIVE

The aims of this study were to analyze the role of fine-needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules and to analyze the malignancy risk of thyroid nodules by studying the association between autoimmune thyroiditis and thyroid cancer.

METHODS

We conducted a retrospective study on 111 patients with thyroid nodules diagnosed in childhood or adolescence. FNAB was performed in 46 participants with thyroid nodules after ultrasonography (US). Cytology diagnoses were categorized as insufficient, benign, suspicious, and malignant. Clinical and surgical follow-up data were obtained from medical records. The clinical correlation and accuracy of FNABs were evaluated.

RESULTS

The family history was positive in four patients. Forty-six patients had positive antithyroid antibodies and an inhomogeneous hypoechogenic US pattern. One patient had previous neck irradiation history. Eighty-six patients (%77.5) were euthyroid. All patients underwent US examination. The FNAB results of the 46 patients were 29 (63%) benign cases, 7 (15%) insufficient, and 10 (22%) suspicious patients. Malignancy was not reported at all. A repetition of FNAB in two benign cases, which were diagnosed with papillary carcinoma during followup, reported these cases as suspicious. Ten patients with suspicious FNAB results underwent surgery because of increases in the size of the nodules; two patients were diagnosed with papillary carcinoma. In this study, the prevalence of malignancy was 4.5% in patients with thyroid nodules.

CONCLUSION

In this study, the importance of FNAB in the diagnosis and follow-up of thyroid nodules in childhood has been observed, and risk factors, such as history of familial thyroid carcinoma, radiotherapy to the neck at younger ages, suspicious cytological findings, and increased nodular sizes during follow-up in cases with Hashimoto thyroiditis have been correlated with increased thyroid carcinoma malignancy risk.

Development of a Hodgkin disease tumor in the neck of a patient who previously had undergone complete excision of a hyaline-vascular Castleman disease neck mass

Castleman disease is an uncommon cause of a neck mass. A benign lymphoproliferative disorder, it may be seen as a self-limited unicentric process or as a fulminant multicentric disease with systemic symptoms. The association between Hodgkin disease and Castleman disease has been debated extensively, but this association is rare. The associated Hodgkin disease frequently has been of the interfollicular subtype and typically has coexisted with the multicentric plasma-cell variant of Castleman disease. We report a case of mixed-cellularity Hodgkin disease of the neck in a patient previously diagnosed with hyaline-vascular-type Castleman disease who had undergone complete excision of a neck mass 2 years earlier.

Vascular endothelial growth factor, vascular endothelial growth factor receptor-3 and cyclooxygenase-2 expression in psoriasis

OBJECTIVE

To investigate expression patterns and relationship of vascular endothelial growth factor (VEGF), vascular endothelial receptor-3 (VEGF-R3) (FLT-4) and cyclooxygenase-2 (COX-2) in psoriasis.

STUDY DESIGN

Forty-three patients were included in this study. The clinical severity of psoriasis was assessed using the psoriasis area and severity index (PASI). Punch biopsy samples both from psoriatic and nonlesional skin were taken and VEGF, VEGF-R3 and COX-2 expressions determined.

RESULTS

VEGF, VEGF-R3 and COX-2 expressions were detected in 90.9%, 78.0% and 86.4% of psoriatic and 84.1%, 71.8%, and 84.1% of nonlesional skin, respectively. Epidermal VEGF, VEGF-R3 and COX-2 expressions were detected in 56.8%, 77.8% and 34.1 of psoriatic and 75%, 78.1% and 65.9% of nonlesional skin, respectively. In dermis, VEGF, VEGF-R3 and COX-2 expression was observed in 88.6%, 77.5% and 84.1% of psoriatic and 81.8%, 64.1% and 77.3% of nonlesional skin, respectively. Among the PASI subgroups no statistically significant differences were detected for VEGF, VEGF-R3 and COX-2 expression.

CONCLUSION

Our study demonstrated that VEGF, VEGF-R3 and COX-2 expression in psoriatic and nonlesional skin is significantly high in epidermis and dermis. Although there was significant concordance between VEGF and VEGF-R3 expressions in psoriatic lesions, there seems to be no concordance between the others.

External cystic rectal duplication: an unusual presentation of rectal duplication cyst

Duplications of gastrointestinal tract are rare anomalies, and rectal duplications account for five percent of the alimentary tract duplications. We present an unusual case of rectal duplication, which was located externally in a newborn female, and discuss the types of distal hindgut duplications.

Expressions of vascular endothelial growth factor and CD34 in oral aphthous lesions of Behçet's disease

OBJECTIVE

Behçet's disease (BD) is an immunoin-flammatory vasculitis with an unknown etiopathogenesis. Vascular endothelial growth factor (VEGF) is a cytokine-stimulating angiogenesis. It has been suggested to play a role in inflammation and pathogenesis of vasculitic processes.

STUDY DESIGN

VEGF and CD34 expressions were assessed in samples taken from oral aphthous lesions. The patients were evaluated for disease activity, duration of lesions, serum C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR).

RESULTS

Twenty-six patients were included. Fourteen (53.9%) had increased CRP levels and 12 (46.1%) had increased ESR levels. Positive VEGF and CD34 staining were detected in 46.2% and 69.2% of biopsy samples, respectively. There was good positive correlation between them. The frequency of positive VEGF and CD34 staining was statistically higher in lesions with a duration of more than 6 days. No correlation was found between positive VEGF staining and serum CRP level, ESR and disease activity.

CONCLUSION

Increased VEGF expression in correlation with CD34 positivity in oral aphthous lesions may show the role of VEGF in pathogenesis of these vasculitic lesions. We have concluded that VEGF may play a role during the course of oral aphthous lesions in BD.

Antiviral activity of Sanicula europaea L. extracts on multiplication of human parainfluenza virus type 2

The antiviral activity of Sanicula europaea L. extracts against human parainfluenza virus type 2 (HPIV-2) was examined. The extract prepared from the leaves of the plant and a fraction separated from the crude extract with gel filtration chromatography were found to inhibit HPIV-2 replication without any toxic effect on Vero cells. The acidic fraction obtained from the crude extract of S. europaea leaves was found to be the most active fraction with plaque inhibition assay at non-cytotoxic concentrations. Unfortunately, antiviral activity was not detected in the molecules purified from the crude ethanol extract of Sanicula leaves.

Intracranial meningiomas. Analysis of 344 surgically treated cases

The authors present 344 (230 females, 114 males) surgical cases of intracranial meningioma. A total of 370 interventions (344 primary procedures, 10 reexplorations for neurologic deterioration, 16 operations for recurrence) were made. Mean follow-up was 38 months. The overall evaluation revealed that 306 (88.95%) patients were completely normal or in a better condition than before operation. 18 (5.23%) were in a worse condition after operation and 20 (5.81%) died. Results suggested that complications and mortality were mostly related to localization and large volume; we also still have problems with aggressive and malignant meningiomas.

Anterior pontine hydatid cyst: case report

We report a rare case of anterior pontine hydatid cyst. Diagnosis was established on magnetic resonance imaging (MRI) findings preoperatively and was confirmed during surgery and by laboratory findings of cyst fluid, and section of cyst wall. A classical suboccipital craniectomy was performed, followed by an approach through the floor of the fourth ventricle. After a failed attempt at the Dowling technique, we punctured the cyst, aspirated the contents, then extirpated the cyst membrane. The patient survived suffering only minor morbidity. The surgical technique and pontine myelotomy are discussed.

Saniculoside N from Sanicula europaea L

Extracts from the aerial parts of Sanicula europaea L. were investigated for their anti-HIV activity, and the 50% ethanolic extract was shown to exhibit the highest activity. A new triterpene saponin glycoside, 21 beta-(angeloyloxy)-3-O-[beta-D-arabinopyranosyl(1-->4)-beta- D-glucopyranosyl (1-->3)-beta-D-glucuronopyranosyl propyl ester]-3 beta,15,16,22 alpha,28 beta-pentahydroxy-delta(12)-oleanene, saniculoside N (1), in addition to the known phenolic acids, rosmarinic acid (2), and caffeic acid (3) were isolated as major components. Rosmarinic acid was established as the principal active substance.

Spinal extradural metastasis from a medulloblastoma

Medulloblastoma metastasising extraxially is a rare entity. The mechanisms that cause such spread are not fully understood. We present a patient who developed a low thoracic metastasis three years after surgical removal of a posterior fossa medulloblastoma. A spinal metastasis penetrated the dura, thus becoming extradural and from this tumour a completely extradural lumbal metastasis developed. Simultaneous local recurrences of systemic metastases were not noted.

Association of von Recklinghausen's neurofibromatosis and aqueduct stenosis

We present 6 patients with a definite diagnosis of von Recklinghausen's neurofibromatosis. All of them had aqueductal stenosis and hydrocephalus requiring surgical intervention because of clinical signs of increased intracranial pressure confirmed by pressure measurements.

Tension pneumocephalus after transsphenoidal surgery: case report

The authors present a patient who underwent transsphenoidal surgery for a pituitary adenoma and afterward developed late, severe rhinorrhea and tension pneumocephalus. The patient was treated conservatively.

Intracerebral hemorrhage and hematoma in Behçet's disease: case report

The authors describe a patient with Behçet's disease who suffered from intracerebral hemorrhage 2 1/2 years after the initial diagnosis. There is strong evidence that this situation is not merely a coincidence; rather, these two abnormalities have a cause and effect relationship.

Craniopharyngioma of the cerebellopontine angle. Case report

The authors report a case of craniopharyngioma presenting in the right cerebellopontine angle. The tumor was removed totally. The purpose of this report is to record this very unusual localization of a craniopharyngioma.