Syringocystadenoma papilliferum arising in a naevus sebaceous

Naevus sebaceus is a cutaneous hamartoma with the potential of developing into benign or malignant neoplasms. Syringocystadenoma papilliferum (SCAP) have been reported to originate from naevus sebaceus. SCAP is a rare, benign adnexal skin tumour of apocrine or eccrine type of differentiation which typically presents as a nodule or a plaque on the scalp or face. We report a case of syringocystadenoma papilliferum arising in an undiagnosed pre-existing naevus sebaceus in a 56-year-old female.

Chronic Obstructive Pulmonary Disease Mismatch: A Case of Tracheal Hamartoma

OBJECTIVE

To demonstrate the diagnostic challenge of tracheal hamartoma in a patient with chronic obstructive pulmonary disease (COPD).

CLINICAL PRESENTATION AND INTERVENTION

A 65-year-old man with COPD was admitted with sudden onset of asphyxia attacks related to the position of his body. Computerized tomography (CT) of the neck showed a soft tissue mass with calcification, which occluded more than two-thirds of the proximal part of the trachea. The tumor was completely removed, and histopathology confirmed hamartoma.

CONCLUSION

This case report showed the detection of a primary tracheal tumor on CT. This finding enabled the correct diagnosis and led to appropriate treatment in the form of surgery.

Hair and Scalp Disorders in a Tuscan Pediatric Dermatological Outpatient Clinic: A Clinical and Epidemiological Evaluation

OBJECTIVES

The aim of this study was to evaluate the clinical and epidemiological profile of hair and scalp disorders in children referred to the Pediatric Dermatology Outpatient Clinic.

MATERIALS AND METHODS

We performed a retrospective study of children with hair loss problems or scalp diseases who turned to the Pediatric Dermatology Service, Anna Meyer Pediatric Hospital, Florence, Italy, from January 1, 2009, to December 31, 2009. Demographics, personal and familial medical history, laboratory tests, clinical examination, final diagnosis and therapeutic interventions were obtained from the manual chart review.

RESULTS

Of the 2,640 children who had access to the Pediatric Dermatology Service, 190 (7.19%) had a hair or scalp disorder. Among the 190 children, 60 (31.57%) presented with nonscarring alopecia, 56 (29.47%) had benign neoplasias, hamartomas or vascular malformations of the scalp, 51 (26.84%) had scalp inflammatory diseases, 14 (7.36%) had scarring alopecia, 5 (2.63%) had infections and 2 (1.05%) had infestation of the scalp. A case of constitutional hypertrichosis (0.52%) and also a case (0.52%) of lamellar ichthyosis were diagnosed.

CONCLUSIONS

Our results underline that hair and scalp diseases represent an important percentage of admittances to a dermatological pediatric outpatient clinic. The variety and complexity of the diseases observed in this study included diseases commonly found also in adulthood.

Pediatric-onset gelastic seizures: clinical data and outcome

Gelastic seizures are an extremely rare form of epilepsy defined as automatic bouts of laughter without mirth commonly associated with a hypothalamic hamartoma. The objective was to survey all Israeli children found to develop recurrent gelastic seizures and report presenting symptoms, electroencephalographic and radiologic data, and response to either antiepileptic drugs or surgery. Ten children who developed gelastic seizures at the age of 1 week to 6.5 years (mean, 25 months) at a frequency from 3 bouts per week to >10 prolonged bouts per day were followed for a period of 1.3-12 years (mean, 6 years). Seven cases were defined as symptomatic: cortical magnetic resonance imaging revealed a hypothalamic hamartoma in four patients and cortical abnormalities in three others. Seizure control was achieved in four patients, including a neonate with status gelasticus and hypothalamic hamartoma, and partial control in one more. Five children remained resistant to polytherapy, including three with hypothalamic hamartoma even after two of them underwent hemartoma excision. Thus, children with gelastic seizures may respond relatively well to drug therapy. Four of the 10 patients became seizure free with drug therapy; in three intractable symptomatic cases, surgery was tried but failed in two of the three.

Incidence and cytological features of pulmonary hamartomas indeterminate on CT scan

OBJECTIVE

Pulmonary hamartomas have a characteristic heterogeneous radiological appearance. However, when composed predominantly of undifferentiated mesenchymal fibromyxoid component, their homogeneous appearance on computed tomography is indeterminate for malignancy. Rendering an accurate preoperative diagnosis in these cases can alter management. The aim of this study was to determine the incidence and accuracy of cytodiagnosis for hamartomas 'indeterminate' by imaging.

METHODS

We retrospectively reviewed records for hamartomas diagnosed by transthoracic fine needle aspiration (FNA) including immediate impressions and final diagnoses. Cytological features evaluated included the presence of fibromyxoid stroma, bronchioloalveolar cell hyperplasia, fibroadipose tissue, cartilage and smooth muscle.

RESULTS

Eighteen (1.3%) hamartomas were identified from 1355 transthoracic FNAs. The immediate impression was hamartoma in 13 (72%), carcinoid in one (6%), mucinous bronchioloalveolar carcinoma in two (11%) and non-diagnostic in two (11%). The final diagnosis of hamartoma in cases diagnosed as carcinoid, mucinous bronchioloalaveolar carcinoma and non-diagnostic on immediate impression was rendered following assessment of all cytological material.

CONCLUSION

Overall, FNAs are highly reliable for diagnosing hamartomas even when composed principally of undifferentiated mesenchymal fibromyxoid stroma, especially with the aid of all available preparations including Diff-Quik smears, Papanicolaou smears, ThinPreps and cell block material.

Bile duct hamartomas--the von Meyenburg complex

Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by fibrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

Hamartome de la rate (splénome) chez un enfant drépanocytaire

Hamartomas of the spleen or splenomas are uncommon benign lesions that predominantly occur in adults. We report a case of an 11-year-old girl with sickle cell anemia who had a single splenic 1.8 cm nodule incidentally found during splenectomy and histologically characterized by disorganized red pulp tissue without interspersed white pulp leading to the diagnosis of hamartoma. The association of hamartoma and hematological conditions is a very unusual condition in children.

Hypothalamic Hamartoma and Infantile Spasms

PURPOSE

A small number of patients with hypothalamic hamartoma (HH) present with infantile spasms (IS) as an initial or early seizure type. We describe the clinical features of IS associated with HH.

METHODS

Our series of patients with HH and epilepsy was reviewed to identify cases with a history of IS. The clinical features and neuroradiological findings in this study group were compared to a control group of patients with HH and refractory epilepsy, but without a history of IS.

RESULTS

We identified six patients with HH and a history of IS in this series (n = 122, 4.9%). Five of the six are male. Four of the six patients (67%) developed IS as their first seizure type. The mean age for onset of IS was 6.2 months (range 4-9 months). Results of electroencephalographic (EEG) study at the time of IS diagnosis showed hypsarrhythmia in two (33%). Five patients were treated with adrenocorticotropic hormone (ACTH), and four of the five (80%) responded with control of IS. However, these patients developed other seizure types, and were ultimately refractory to medical management. Aside from the IS, no significant differences in clinical and imaging features were determined between the study group and the control group.

CONCLUSIONS

HH should be included in the differential diagnosis for infants presenting with IS. These patients may have hypsarrhythmia on initial EEG, and may respond to ACTH treatment with improvement of IS. However, all became refractory with other seizure types, more commonly seen in HH patients. Focal pathologies associated with IS may be subcortical, as well as cortical, in nature. We have not identified any predictive features for the occurrence of IS in the HH population.

Relative Frequency of Central Odontogenic Tumors: A Study of 1,088 Cases from Northern California and Comparison to Studies from Other Parts of the World

PURPOSE

To determine the relative frequency of central odontogenic tumors in relation to all biopsy specimens and to one another in an oral pathology biopsy service and to compare the data with previous studies from different parts of the world.

METHODS

Files from the Pacific Oral Pathology Laboratory of the University of the Pacific, San Francisco, CA served as a source of material for this study. Files were systematically searched for all cases of central (intraosseous) odontogenic tumors during a 20-year period.

RESULTS

Central odontogenic tumors were identified in 1,088 (1.2%) cases out of the 91,178 accessed. Individually, of all odontogenic tumors, 75.9% were odontomas. The prevalence of the remaining tumors appears to be a rare occurrence. The second most common was ameloblastoma (11.7%), followed by odontogenic myxoma (2.2%). Odontomas are considered hamartomas or developmental anomalies. When excluded from the list of individual odontogenic tumors, ameloblastoma is the most common (48.5%), followed by odontogenic myxoma (9.2%), adenomatoid odontogenic tumor (7.3%), ameloblastic fibro-odontoma (7.3%), ameloblastic fibroma (6.5%), calcifying odontogenic cyst (6.5%), and odontogenic fibroma (6.1%). Each remaining tumor comprises less than 4%.

CONCLUSIONS

Studies related to the relative frequency of individual odontogenic tumors from different parts of the world are difficult to compare because most studies are outdated, the list of tumors is limited, and new entities are not included. To determine the real relative frequency, further studies should be conducted, especially in Western societies, by experienced pathologists in the field of odontogenic tumors.

Prevalence of benign disease in patients undergoing resection for suspected lung cancer

BACKGROUND

In this era of expanded lung cancer screening, accurate differentiation of benign from malignant lesions remains an important problem. We sought to characterize our experience with focal pulmonary lesions suggestive of lung cancer and subsequently proven benign on surgical resection.

METHODS

A retrospective analysis was performed on 1,560 patients who underwent resection for focal pulmonary lesions at our institution from January 1995 to December 2002. Computed tomography and pathology reports were reviewed for all patients. Fluorine-18-fluorodeoxyglucose positron emission tomography studies were performed on 43 patients.

RESULTS

Benign processes were found on pathologic examination in 140 patients (9%). Resection was accomplished by thoracotomy in 103 patients (74%), video-assisted thoracoscopy in 36 patients (26%), and sternotomy in 1 patient (0.7%). Seventy patients (50%) underwent mediastinoscopy before resection. There was 1 (0.7%) perioperative death. Pathologic diagnoses from the pulmonary resections revealed granulomatous inflammation in 91 patients (65%), hamartoma in 17 patients (12%), pneumonia or pneumonitis in 14 patients (10%), fibrosis in 5 patients (4%), and other in 13 patients (9%). Fluorine-18-fluorodeoxyglucose positron emission tomography imaging suggested malignancy in 22 of 43 patients and benign lesion in 20 of 43 patients (1 study was not interpretable). Thirty-eight patients underwent needle biopsy before surgery. Of these, 29 samples were nondiagnostic, 5 samples were negative, and 4 samples were considered positive for malignancy.

CONCLUSIONS

Despite thorough clinical assessment, advanced imaging technology, and needle biopsy, many patients continue to undergo surgery for benign disease. Aggressive attempts to diagnose and treat early stage lung cancer must be tempered with this understanding.

Status gelasticus after temporal lobectomy: ictal FDG-PET findings and the question of dual pathology involving hypothalamic hamartomas

PURPOSE

To present the first ictal fluorodeoxyglucose-positron emission tomography (FDG-PET) evidence of the hypothalamic origin of gelastic seizures in a patient with a hypothalamic hamartoma (HH) and to raise the issue of true dual pathology related to this entity.

METHODS

Ictal FDG-PET was acquired during an episode of status gelasticus with preserved consciousness, in a patient previously operated on for complex partial seizures (CPSs) due to a temporal lobe epileptogenic cyst.

RESULTS

Ictal hypermetabolism was localized to the region of the HH during the status gelasticus. CPSs had been completely eliminated after temporal lobe surgery.

CONCLUSIONS

Ictal FDG-PET independently confirmed that gelastic seizures in patients with HH do originate in the diencephalic lesion. An HH may coexist with another epileptogenic lesion, in a context of dual pathology.

Eye disorders in neurofibromatosis (NF1)

Neurofibromatosis type 1 (NF 1) is an autosomal dominant disorder with high index of spontaneous mutations and extremely varied and impredictible clinical manifestations. The aim of this work was to give an account of eye disorders in NF1. 132 patients of age 0-16 years with NF1 were followed up for 15 years. They were checked repeatedly for ophthalmologic disorders. Frequent eye disorders were: Lisch nodules (Iris hamartomas, IH) 78%, hyperthelorism 19.7%, bulbomotoric disorders 15.9%, disorders of the optic disc 16.7% and optic gliomas (18.9%). The highest incidence of eye disorders by NF1 patients showed Lisch nodules (IH). Its ease of clinical recognition and if present with other diagnostic signs (for instance café au lait patches) could be deemed as reliable diagnostic criterion of NF1 in childhood.

Recognition of the various expressions of anxiety, psychosis, and aggression in epilepsy

Anxiety, psychosis, and aggressive behavior are among the frequent comorbid psychiatric disorders identified in patients with epilepsy. Often the clinical manifestations of these disorders vary according to their temporal relation relative to seizure occurrence. Thus, postictal symptoms of anxiety or psychosis differ in severity, duration, and response to treatment with interictal symptomatology. Psychiatric symptomatology in epilepsy can appear concurrently with the seizure disorder and improve or remit on the abolition of epileptic activity. We refer to these as paraictal psychiatric phenomena. Such is the case of aggressive disturbances associated with gelastic seizures caused by hypothalamic hamartomas. In this article, three case studies are presented to illustrate the importance of distinguishing psychiatric symptoms of anxiety, psychosis, and aggression, with respect to their temporal relation with seizure occurrence.

Primary tumours of the liver in children: an African perspective

Primary tumours of the liver present diagnostic and management difficulties. In Africa, outcomes reflect limitations imposed by comorbidity and lack of resources, both human and material, for major liver resection. Whilst hepatoblastoma and hepatocellular carcinoma can be readily distinguished on clinical and biochemical grounds, there is a high incidence of sarcomatous tumours that mandate biopsy. In our experience, hepatocellular carcinoma in childhood is a lethal condition, usually bilateral and associated with hepatitis B infection. Sarcomatous tumours are often resectable but have a high rate of local recurrence. Hepatoblastoma is a surgically curable tumour in many patients. Resection for benign liver tumours can be safely accomplished and augments institutional experience with major liver surgery.

Laryngeal hamartoma

OBJECTIVE

Hamartoma is a rare finding in the head and neck area and usually occurs as an age-related tumor in the lung. The aim of this study was to present the results of long-term follow-up of a case of laryngeal hamartoma (LH) and review the relevant literature.

MATERIAL AND METHODS

A case of LH is presented which occurred in a 5-year-old child with a previously unreported change in the histologic pattern at recurrence. The relevant literature is critically reviewed with emphasis on histopathological aspects, clinical signs, age and gender.

RESULTS

A total of 26 patients matched the search criteria, of whom 17 (65%) were male. LH occurred in 10 children (mean age 1.9 years) and 9 adults (mean age 49.6 years). Stridor, dysphonia and hoarseness were the commonest symptoms, occurring in 14 patients in total. In 18 patients the tumor presented as a supraglottic lesion (69%). Two neonates died shortly after the diagnosis was made. The current patient is the first to have presented with a change in the histological subtype.

CONCLUSION

LH should be included in the differential diagnosis of benign laryngeal lesions, particularly in children. Complete surgical removal is the method of choice but should be limited in order to preserve laryngeal function, as the prognosis of patients with LH is excellent.

Hypothalamic hamartoma with gelastic seizures in Swedish children and adolescents

BACKGROUND

Hypothalamic hamartoma with gelastic seizures (HHGS) is an uncommon, often unrecognized, epileptic syndrome with onset of symptoms during childhood.

AIM

In order to study the occurrence, clinical symptoms and different investigations of HHGS in Swedish children and adolescents, a nationwide survey was undertaken. Methods. Twelve patients, three females, aged 5 to 19 years were identified and their hospital records reviewed. MRI examinations were reinvestigated.

RESULTS

Gelastic seizures were noted before the age of six months in seven patients in at least three as early as the neonatal period. During the course of disease one or more other seizure types developed in 11 patients. Behaviour disorder became subsequently obvious in ten patients, and mental retardation was diagnosed in seven. Precocious puberty was diagnosed in five patients. A total of 46 MRI examinations were performed in 11 patients, revealing hypothalamic tumors, eight of which were drooping with a broad base. Interictal and ictal EEG examinations were pathological in 10 patients with nonspecific results. Nonspecific results were also found on SPECT and PET performed in six and two patients, respectively. Available antiepileptic drugs had little or no effect on gelastic seizures, but some effect on other seizure types. Precocious puberty was treated with a GnRH-agonist. Neurosurgical treatment of the hypothalamic hamartoma, performed in three patients, had a rather good outcome concerning gelastic seizures and behaviour. Vagal nerve stimulation in five patients had no effect.

CONCLUSIONS

Review of the literature and experience from this group's own cases confirms that early diagnosis of HHGS is important. Hypothalamic hamartoma should be considered in any child with laughing attacks. MRI investigation is compulsory, and neurosurgery the most important treatment.

Association of morphological characteristics with precocious puberty and/or gelastic seizures in hypothalamic hamartoma

The pathogenesis of central precocious puberty (PP) and/or gelastic seizures due to a hypothalamic hamartoma (HH) is still under debate. We evaluated the association of clinical symptoms with morphology and localization of the HH in 34 patients. The majority (86.4%) of HHs in patients with isolated PP (n = 22; 68.2% females) revealed a parahypothalamic position without affecting the third ventricle (91%). Half of them were pedunculated, and 40.9% showed a diameter less than 10 mm. In contrast, 11 of 12 patients with seizures, eight of whom were male, presented with a sessile intrahypothalamic hamartoma, 10 of which distorted the third ventricle. Logistic regression analysis revealed an increased relative risk (RR) for epilepsy in males (RR, 4.3; 95% confidence interval, 0.96-19). However, combination of the risk factor gender with intrahypothalamic position (RR, 19; 1.3-285) and distortion of the third ventricle (RR, 10; 0.6-164) reduced the risk associated with male gender to 1.1. The position of a HH and involvement of the third ventricle are likely to be more predictive for clinical characteristics than size and shape. Male gender was associated with an intrahypothalamic HH and epilepsy, suggesting a sexually dimorphic developmental pattern of this heterotopic mass.

Chorioangioma--new insights into a well-known problem. I. Results of a clinical and morphological study of 136 cases

AIMS

Chorioangiomas are rare hamartomatous lesions. Possible correlations between their occurrence and the progression of a pregnancy have been objects of discussions for quite some time.

METHODS

In a retrospective study 22439 unselected placentas were examined for incidences of chorioangiomas, morphological features and accompanying clinical characteristics.

RESULTS

Chorioangiomas occur in 0.61% of pregnancies, they are mainly microscopically small, and 55% of them are localized subchorial. The rate of their occurrence rises almost linearly with maternal age; chorioangiomas are found most often in women who are over 30 years old. Hypertension and diabetes are found more often in combination with chorioangiomas than they are in otherwise normal pregnancies. In 72% of all cases girls were born; in 33% we also observed malfunctions in the maturation processes of the placental parenchyma, in particular arrested and delayed maturation of the villi. Premature births occur approximately three times more often in chorioangioma pregnancies than in normal ones. Chorioangiomas are often found in primipara and twin pregnancies.

Characteristics of Lisch nodules in patients with neurofibromatosis type 1

PURPOSE

To assess the prevalence and location of Lisch nodules among patients with neurofibromatosis type 1.

PATIENTS AND METHODS

This was a prospective observational case series in which 369 consecutive patients from a neurofibromatosis clinic participated. Predetermined inclusion and exclusion criteria were applied to these participants. The presence of Lisch nodules was determined by one of the authors (SMC). The percentage of patients with neurofibromatosis type 1 with Lisch nodules was calculated. Lisch nodules were characterized as being distributed superiorly, inferiorly, or equally in each eye. The percentage of eyes in each group was ascertained.

RESULTS

Among patients of all ages with neurofibromatosis type 1, 63.2% had Lisch nodules, whereas 92% of postpubertal patients had Lisch nodules. Among eyes with Lisch nodules, 80% had an inferior distribution.

CONCLUSIONS

This study corroborated previously reported data regarding the prevalence of Lisch nodules in patients with neurofibromatosis type 1 and found that Lisch nodules were predominantly located inferiorly on the iris. The authors propose that exposure to sunlight may be the mechanism for this distribution of hamartomatous nodules.

Mesonephric remnants of the prostate: incidence and histologic spectrum

Mesonephric remnants in the prostate are an unusual mimic of adenocarcinoma with unknown incidence. This condition is considered benign, similar to its counterpart in the female genital tract, but there have only been six cases reported to date, so the histologic spectrum of this finding is uncertain. To determine the incidence and comparative histopathology of this finding, we reviewed all transurethral resections of the prostate obtained at Mayo Clinic (Rochester, MN) in 1989 to identify cases of mesonephric remnants. Among 698 prostatic transurethral resection specimens, we identified 4 cases of mesonephric remnants (0.6% incidence), all in association with nodular hyperplasia. Patients ranged in age from 66 to 82 years (mean, 72 y) and had typical urinary obstructive symptoms; follow-up was obtained in these 4 cases. Four additional consultation cases and one needle biopsy case were also included in this study. Histologically, mesonephric remnants consisted of a proliferation of benign acini arranged in lobules or showing infiltrative growth between smooth muscle bundles without stromal desmoplasia. The acini were typically round or oval, varied in size and spacing, and lined by a single layer of low cuboidal cells with scant to moderate cytoplasm and inconspicuous small nucleoli. The cells of mesonephric remnants were not reactive with antibodies to prostate-specific antigen (eight of eight cases) or with prostatic acid phosphatase (seven of seven cases); high-molecular weight cytokeratin 34betaE12 was positive in the basal cells (six of eight cases). Our results indicate that mesonephric remnants are present in <1% of transurethral resections and are rarely identified in needle biopsies. The acini are lobular or infiltrative and may be architecturally mistaken for adenocarcinoma. This cytologically innocuous finding is probably underreported and interpreted as benign prostatic acini, but this is of no apparent clinical consequence. Immunohistochemical studies with antibodies to PSA and keratin 34BE12 are helpful in separating mesonephric remnants from adenocarcinoma, similar to the case of other benign mimics.

The clinical spectrum of duodenal polyps in pediatrics

OBJECTIVES

The aim of this retrospective study was to determine the prevalence, clinical presentation, and histologic subclassification of duodenal polyps identified on endoscopy (EGD) in pediatric patients.

METHODS

We performed an 18-year retrospective study of all pediatric patients (< 21 years) with duodenal polyps diagnosed between 1983 and 2001 at The Johns Hopkins Children's Center. Our analysis includes a formal histologic evaluation of duodenal polyps either biopsied using cold-forceps or removed by snare cautery.

RESULTS

Duodenal polyps were reported in 22 of 5766 EGDs (0.4%) performed in 16 (M:F; 1:1) patients with a mean (SD) age of 14.1 (5.1) years. Polyps were equal in both the Caucasian and African American population (adjusted ratio 1.2:1). The histologic subtypes included Adenomatous (42%), Brunner's gland hyperplastic (33%), hamartomatous (17%), and heterotopic gastric gland polyps (8%). The most frequent indication for EGD was surveillance in patients with polyposis syndromes; most of these patients were asymptomatic at the time of their EGD. In comparison, the most frequent indication for an EGD in patients without polyposis syndromes was abdominal pain and vomiting.

CONCLUSIONS

Duodenal polyps are most frequently encountered in children with polyposis syndromes, most of whom are asymptomatic. In nonsyndromic patients, the most common histologic subtype is Brunner's gland hyperplastic polyp and presenting symptoms include abdominal pain and vomiting.

[Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules]

OBJECTIVES

Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to obtain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS.

MATERIAL AND METHODS

From July 1992 through April 2001, 182 patients were operated on for SPN in our department.

DESIGN

Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation.

RESULTS

A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications.

CONCLUSIONS

VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases.

Sebaceus naevi: a clinicopathologic study

OBJECTIVE

To analyse sebaceus naevus (SN) incidence, associated malignancies, and developmental defects in a retrospective study.

METHODS

We retrospectively analysed all cases of SN excised in our Department over a 20-year period. All cases of epidermal naevus syndrome (Schimmelpenning syndrome) associated with SN were recorded, as well as all patients with histological changes suggesting degeneration of the initial SN.

RESULT

A total 226 patients with SN were included in the study. Stage II was the most common (65%), and the parietal area was the most common location of SN (42%), with only 7% located in non-scalp areas. Syringocystadenoma papilliferum and trichoblastoma were the most common tumours arising on SN. We only found five patients with basal cell carcinoma arising on previous SN. Epidermal naevus syndrome associated with SN was diagnosed in 16 patients, and this was the most common neurocutaneous association.

CONCLUSION

The incidence of malignancy arising on SN was very low, indicating that prophylactic surgery of NS in children is not recommendable. Developmental defects should be investigated in order to evidence possible epidermal naevus syndrome associated with SN.

Primary cardiac tumours in a paediatric population

OBJECTIVE

To review the presentation, diagnosis, histology and outcome of primary cardiac tumours presenting to a paediatric cardiac unit over a 20-year period.

METHODS

Hospital records and data bases were searched for the years 1980-2000.

RESULTS

There were 12 patients with four histological tumour types including a predominance of rhabdomyoma, as well as myxoma, fibroma and myocardial hamartoma. Diagnosis was made in utero, by ultrasound in five cases and in the neonatal period in a further three cases. Six cases (50%) required surgical intervention and there were three tumour-related deaths. Two infants with large left ventricular tumours diagnosed in utero developed univentricular physiology, acting like hypoplastic left heart syndrome at birth.

CONCLUSIONS

Despite an absence of malignant histology there was significant mortality and morbidity among the patients reviewed. The development of univentricular physiology in infants with large left ventricular tumours is rare and is a difficult management problem.

Oral tumors in children: a review

The objective of this study was to present an analysis of the incidence and diagnosis of 172 oral tumors in Jordanian children and adolescents. During the period of evaluation, 1605 patients with oral cavity tumors were seen. Of which 172 (11%) were in children under 18 years, who were treated after histopathological confirmation of the diagnosis during the 18 years 1980-1998. Diagnosis, incidence and age at presentation were the main outcome measures, and the results showed that 156 patients (91%) had benign tumors and 16 patients (9%) were malignant. The most common benign tumor was haemangioma 24 (14%), and the most common malignant tumor was sarcoma 15 (8.5%). The most common odontogenic tumor was odontoma 35 (20%), and non-odontogenic tumor, ossifying fibroma 4 (2%). The most common site of soft tissue tumors was the lip 25 (14.5%), and of bony tumors the mandible 43 (25%). About 40% of the tumors developed in patients between the ages of 6 and 12 years. Most of the hemangiomas and lymphangiomas developed in patients less than 6 years old, and most of the ameloblastomas in those over 12 years of age. These data are important to assess geographical differences in the incidence of lesions and to all clinicians to make realistic judgments in counseling patients before biopsy about the probability of diagnosis. Most of these lesions were probably developmental malformations rather than neoplasms.

[Skin changes in newborn infants in the first 5 days of life]

BACKGROUND AND OBJECTIVE

To prospectively survey skin lesions in a large group of newborns, as no such study has as yet been performed in Germany.

PATIENTS/METHODS

In a prospective study, we examined one thousand newborn babies twelve to 120 hours old.

RESULTS

In 59.7%, one or more skin lesions could be detected, some of which were only transient. Noticeable differences from other studies included a higher incidence of congenital melanocytic nevi (6%) and port wine stains (2.8%). Instead of the usual male:female ratio of 1:2 we found a 1:1 ratio for port wine stains. Toxic erythema of the newborn and milia were less frequent than in other studies.

CONCLUSIONS

With a frequency of 37.2%, vascular lesions such as nevus flammeus and hemangioma are the most common skin lesions in newborns. Our study found a higher incidence of congenital melanocytic nevi than reported in literature. An associated of skin lesions and maternal smoking during pregnancy was not detected.

Spontaneous rupture of splenic hamartoma: a case report

Splenic hamartomas are rare. The authors report a case of spontaneously ruptured splenic hamartoma in a 5-month-old boy. This rupture led to the death of the child. If abdominal pain is present and a mass is palpated, the splenic hamartoma should be managed surgically in an expeditious manner. There have been only two known previous reports of spontaneous rupture of splenic hamartoma in adults, but none in children.

Benign intrathoracic tumours. A population survey in northern Finland

Benign intrathoracic tumours are uncommon, but their occurrence in unselected populations is poorly defined. We reviewed all cases of suspected intrathoracic tumour in a population (440,000) in northern Finland during 1990 through 1992. Diagnostic investigations included fiberoptic bronchoscopy and computed tomography in all cases. Of the 653 intrathoracic tumours, 36 were benign. The male/female ratio in these 36 cases was 1.25; the mean age was 54 years. Twenty-three of the lesions were symptomless, found at health check or examination for other disease. Bronchoscopy did not confirm the diagnosis of any benign tumour. Thoracotomy was considered necessary in most cases and histologic diagnosis was therefore available in 24 (67%). Hamartoma was the most common benign lung tumour. This prospective study in an unselected population confirms previous findings in surgical series concerning benign intrathoracic tumours and their histology.

Pulmonary hamartomas

OBJECTIVE

To analyze the clinical and pathologic features of biopsy-proven pulmonary hamartomas at a tertiary referral center.

DESIGN

We retrospectively reviewed institutional data on pulmonary hamartomas for a 17-year study period.

MATERIAL AND METHODS

The Mayo Clinic computerized medical records database was searched for patients who had biopsy, excision, or autopsy diagnosis of pulmonary hamartomas from 1976 through 1992. Medical records and all available histologic sections were reviewed.

RESULTS

Of the 215 patients with histologically confirmed pulmonary hamartoma, 141 were men and 74 were women (approximately a 2:1 ratio). Two hundred eight patients were asymptomatic, 54 of whom were undergoing assessment for a comorbid disease process. Only four patients had new onset of respiratory symptoms. The peak incidence of occurrence was in the seventh decade of life. The mean size of the hamartomas were 1.5 cm (range, 0.2 to 6.0); no lobe was predominantly involved. Most hamartomas were resected by simple or wedge excision. Sixty-three patients (29.3%) had a concurrent neoplasm (most commonly, lung carcinoma). Follow-up ranged from 2 to 192 months (mean, 61). Eight postoperative deaths occurred. No recurrent pulmonary hamartomas developed. In one patient, lung carcinoma developed 33 months after excision of a hamartoma. In a second patient, sputum cytologic findings were abnormal 9 years later. A third patient had biopsy-proven adenocarcinoma metastatic to bone and an indeterminate lung nodule 2 years after resection of a pulmonary hamartoma.

CONCLUSIONS

Pulmonary hamartomas are benign lung neoplasms that, in our referral population occurred most commonly in asymptomatic older men. A substantial number of our patients had concurrent neoplasms; however, many had been referred for cancer treatment. We found no evidence of either a malignant transformation or an unexplained association with other lung neoplasms.

The incidence of birthmarks in Israeli neonates

BACKGROUND

Several studies have documented cutaneous findings in neonates of various racial groups. Our purpose was to determine the frequency of birthmarks in Israeli neonates of Jewish and Arabic origin.

METHODS

A cohort of 1672 newborn infants under 96 hours of age were examined for the presence of birthmarks. Of these 841 (50.3%) were Jewish and 831 (49.7%) were Arab. The Jewish group was further subdivided into various ethnic groups according to parental ancestry.

RESULTS

Melanocytic brown lesions (Mongolian spots, congenital nevi, and café-au-lait spots), were more common in Arab infants. The vast majority of Jewish infants with Mongolian spots were of Asian or African ancestry. On the other hand, congenital melanocytic nevi were found only in Jewish infants of European ancestry. Vascular lesions (salmon patch and port-wine stain) in Arab neonates exhibited a female preponderance.

CONCLUSIONS

Our data suggest that the prevalence of birthmarks in Israeli neonates is similar to the prevalence reported by others in white neonates.

Hamartomas of the chest wall in infants

Chest wall hamartomas in infancy are rare lesions with distinct clinical, radiologic, and pathologic characteristics. Four cases treated at Children's Hospital of Los Angeles are presented and previously reported cases are reviewed. Chest wall hamartomas arise antenatally and present as hard, immobile masses, which may cause respiratory insufficiency. An extrapleural mass arising from the ribs can be seen radiographically. Histologically, these lesions are hypercellular and consist of a disorganized array of mesenchymal tissues endogenous to the chest wall. Rapid growth may occur, but usually is self-limited. Chest wall hamartomas are usually benign. This series includes the malignant transformation of one of these lesions. En bloc resection is curative, but the large residual chest wall defect frequently results in scoliosis.

Reappraisal of breast hamartomas. A morphological study of 41 cases

Mammary hamartomas are breast disorders currently underestimated and not well recognized. Forty-one hamartomas diagnosed among 5,834 breast biopsies, histologically examined during the last 7 years, are reported. Hamartomas accounted for 1.2% of benign lesions and 4.8% of benign breast tumors. Clinically, hamartomas were revealed by breast palpable lump, usually painless. Typically, but inconsistently, mammography showed sharply circumscribed density, separated from adjacent normal breast by a thin radiolucent zone. Macroscopically, hamartomas were slightly larger and softer than common adenofibromas, were well limited, whitish, pinkish and fleshy, with yellow islands of fat tissue. Histologically, hamartomas exhibited pushing borders with a pseudoencapsulation, and consisted of a combination of variable amount of stromal and epithelial components. Stromal components mainly consisted in a prominent fibrohyalin feature usually associated to small islands of adipose tissue and edematous changes. Epithelial structures showed variable features of benign breast disease. The overall architecture was lobulated but not nodular. The histological diagnosis was mainly a diagnosis of exclusion and hamartomas diagnosis relies on clinical, radiological and pathological criteria. Hamartomas result more from breast dysgenesis than from tumorous process.

[Morphological findings in temporal lobe epilepsy: experience with 216 consecutive surgical specimens]

We have examined 216 consecutive surgical specimens of patients with chronic pharmacoresistant temporal lobe epilepsy. Neoplasms were detected in 75 cases (34.7%). All but two of these tumors were of low histopathological grade (WHO-grade I or II). There were 34 gangliogliomas, 17 pilocytic astrocytomas, 9 oligodendrogliomas, 6 fibrillary astrocytomas, and 6 dysembryoplastic neuroepithelial tumors. Fifty-one specimens contained non-neoplastic focal lesions and an additional 13 cases had both tumors and non-neoplastic focal lesions within the same specimen. The most frequent non-neoplastic focal lesions were microscopic glioneuronal hamartias (32 cases), glioneuronal hamartomas (7 cases) and vascular malformations (13 cases). The hippocampal formation was structurally well preserved in 71 specimens and in 51 of these (71.8%) there was Ammon's horn sclerosis. The findings document that intractable temporal lobe epilepsy is associated with significant structural alterations in the great majority of patients.

Facelift surgery: an adjunct in the treatment of capillary malformations (port wine stains)

Hemangiomas and lymphangiomas remain the most common benign tumors seen by the plastic surgeon that involve a neonate's skin and deeper tissues. A significant number of tumors undergo spontaneous regression and require no treatment. The port wine stain (PWS) remains one of the most difficult variants of hemangiomas to treat and continues to be psychologically traumatic throughout a patient's lifetime. Recently, advanced use of laser technology has yielded beneficial results for a significant number of these patients. This report illustrates the incorporation of facelift surgery as an adjunct in the overall management of older patients resulting in decreased use of cosmetics and great improvement in general well being.

Adenomyoma of the stomach. Report of a case and review of the literature

A case of adenomyoma of the prepyloric antrum and a review of the previous reported in the literature are presented. The tumor is composed of cysts and glandular structures lined by cuboidal-to-columnar epithelium surrounded by hypertrophic smooth muscle bundles. Furthermore, glands resembling Brunner's and/or heterotopic pancreatic tissue are present in some patients. The endoscopic characteristics of the lesion are discussed, as well as the diagnostic and therapeutic approaches.

Images of Lisch nodules across the spectrum

The presence of melanocytic hamartomas on the iris, known eponymously as Lisch nodules, is highly characteristic of neurofibromatosis type 1 (NF1). Early recognition of NF1 is vital for optimal detection of associated tumours and for genetic counselling of family members. Although the iris nodules are probably not visible at birth, their prevalence in patients with NF1 gradually increases from birth to about 50% of 5-year-olds, 75% of 15-year-olds and 95-100% of adults over the age of 30. Iris hamartomas in NF1 are elevated, pale brown lesions that vary in appearance depending on the underlying colour of the iris. Colour illustrations are shown in this article, enabling the clinician readily to differentiate hamartomas from other iris lesions.

[Non-neoplastic polyps of the colon]

Non-neoplastic colon polyps are benign lesions with normal histology components, we present our experience with colonoscopy polypectomy in 10 years. We resected 187 polyps in 96 patients (50 males) with medium age of 49.3 years and range 2-82. Most common indication was hemorrhage (37%) taking out the hyperplastic polyps who were found in asymptomatic patients with the highest frequency (41%). Juvenile polyps follows with 25%. 71% polyps were unique but hamaetomatous polyps of Peutz-Jeghers syndrome were multiple (39%). Juvenile (retention) polyps were found among the youngest patients (average 13.2 years) and frequently had hemorrhage (21-25). Lipomas were found in elder patients (range 52.5 years). We had no major complications with hemorrhage or mortality, minor complications were found in 3.09%.

Evaluation of renal masses with contrast-enhanced rapid acquisition spin echo MR imaging

To assess the use of dynamic contrast-enhanced rapid acquisition spin-echo (RASE) imaging for the detection and characterization of renal masses, we evaluated 18 patients with CT evidence of 67 renal masses. The masses included 58 simple cysts, 8 solid neoplasms, and 1 pseudotumor. Patients were examined with standard spin-echo (SE) pulse sequences including pre- and postcontrast T1-weighted images and noncontrast T2-weighted images as well as pre- and postcontrast RASE images. Each pulse sequence was reviewed individually and in a group with other pulse sequences by two blinded observers. The performance of contrast-enhanced RASE imaging either alone or in combination with a T2-weighted SE sequence resulted in improved diagnostic accuracy compared with unenhanced conventional SE and RASE sequences. The contrast-enhanced RASE sequence outperformed the contrast-enhanced T1-weighted SE sequence for one observer; similar diagnostic accuracy was achieved with the two examinations by the other observer. Combining the T2-weighted sequence with contrast-enhanced RASE images did not increase lesion detection but did increase the observers' confidence in making the diagnosis. Contrast-enhanced MR imaging resulted in significant improvement in the detection and characterization of renal lesions compared to unenhanced MR imaging.

Incidence of hepatic hamartomas in tuberous sclerosis

Hepatic hamartomas were thought to be a rare finding in patients with tuberous sclerosis. The purpose of this study was to assess their incidence in children with tuberous sclerosis and to review the literature. During 1984-90 we examined 51 children by ultrasonography; there were 25 boys and 26 girls. Their age ranged from 3 months to 18 years. Liver hamartomas were seen in 12 (23.5%) of the children, more often in girls than boys (5:1). Their incidence increased with age reaching 45% in children over the age of 10. They did not produce any symptoms of hepatic dysfunction. Our study and review of reported cases prove that hepatic hamartomas are a common finding in patients with tuberous sclerosis and may be very helpful in providing a more accurate diagnosis and consequently help in genetic counselling.

Cystic mesenchymal hamartoma of the liver

Two cases of multicystic mesenchymal hamartoma of the liver in children are described. In both cases noninvasive imaging techniques (ultrasound, CT or MR, radionuclide scan) showed a bulky cystic mass suggesting a correct preoperative diagnosis, while selective arteriography defined the operability of the tumor.

[X-ray diagnosis of peripheral chondromatous hamartomas of the lungs]

A roentgenomorphographic picture was compared with gross specimens of the lungs in 104 operated on patients with peripheral harmatochondromas. Eighty three patients were followed-up roentgenologically for 2-18 years. The resultant three variants of an x-ray picture of hamartochondromas were revealed. CT investigation showed a benign process in a majority of patients, hamartochondrosarcoma was diagnosed in 36.5 per cent. Shadow size enlargement, calcifications and their increase are not signs of malignancy.

"Lipomatous" hamartomas and choristomas in inbred laboratory mice

In a retrospective study, 37 male and 19 female inbred laboratory mice, from 1 to 36 weeks of age, were diagnosed with "lipomatous" hamartomas or choristomas from nearly 10,000 mice examined at necropsy over a 24-month period. Hamartomas and choristomas were found to be rare, noninherited tumor-like conditions that occurred spontaneously in 18 inbred strains of mice with a predominance of the conditions in the C3H/HeJ and C57BL/6J strains. Prevalence between strains ranged from 0.6 to 6.2 cases per hundred thousand mice. The 56 cases studied had soft, raised masses that arose on the dorsal midline, primarily above the sutures of the skull. The lesions were prominent on gross examination due to abnormally long hair, change in direction of the hairs, and a change in hair color compared to the normal pelage. Microscopically, the masses consisted of normal adipose tissue in the reticular dermis and subcutis that sometimes extended through the cranial sutures, entering the brain, or expanding into the ventricles. Large masses occasionally contained normal appearing thyroid, intestine, respiratory epithelium lined cysts, squamous epithelial cysts, bone and marrow, cartilage, glands, and angiomatous anomalies. In all cases, the epidermis was intact. Hair follicles were larger in the affected areas of many cases compared to those in adjacent skin. Breeding studies did not yield affected offspring, indicating this is a congenital, noninherited abnormality. This condition resembles "lipomatous" hamartomas, a congenital defect in human beings.

The prevalence and age distribution of peripheral pulmonary hamartomas in adult males. An autopsy-based study

This autopsy-based study defined the prevalence and age distribution of peripheral pulmonary hamartomas in 47,635 southern African miners examined between 1975 and 1988. The prevalence rate for white miners was 7.5/1,000 and for black miners 1.1/1,000. When directly standardised to the white men in the general population, the rates for white and black miners were 7.2 and 5.5/1,000, respectively. The prevalence of peripheral pulmonary hamartomas in both groups increased with age, from 0.8/1,000 in the third decade to 12.0/1,000 in the eighth decade. The study showed a much higher prevalence of peripheral pulmonary hamartomas for whites than previously reported. Furthermore, it documented the occurrence of these benign lung tumours in blacks, a fact that has previously been questioned. There appeared to be no significant difference in prevalence and age distribution between white and black miners, although the database for the black group was deficient for the later decades of life.