Anna Dell'Acqua

Testicular microlithiasis: US findings in six pediatric cases and literature review.

Abstract. The aim of this article is to report on six pediatric cases of testicular microlithiasis (TM) and to review literature reports, in order to schedule US and/or other control examinations, particularly when concomitant focal or diffuse alterations of the testicular parenchymal structure are present, considering the possible association of TM with testicular tumors. Six patients (age range 4–12 years) underwent US examination for scrotal trauma (two cases) unilateral cryptorchidism (one case) follow-up after orchidopexy for bilateral cryptorchidism (one case), and varicocele (two cases). Five examinations were performed with high-frequency probes (10/13 MHz) and seven with 5/7.5-MHz frequency transducers. Follow-up US examinations were performed at different times depending on initial clinical indications, presence of underlying disease, and initial US findings. Two of the six patients underwent three US examinations, two patients underwent two US examinations, and the remaining two patients underwent only one US examination. The patients underwent a total of 12 US examinations. Microliths were bilateral in four patients and unilateral in two patients. In these two latter cases, the contralateral testis was, in one case, cryptorchid and could not be evaluated by US; in the other case it was small and hyperechogenic with orchidopexy sequelae. In three cases microliths were distributed throughout the testis. In the remaining three cases they were present in limited areas of parenchyma. As to the importance of microliths, it was defined as mild in three cases and moderate/severe in three cases. Intratubular testicular microlithiasis is a well-proved histological finding (biopsy or autopsy). More recent is the US demonstration of TM with consequent definition of its pattern: usually bilateral hyperechogenic multiple small foci without acoustic shadows with complete or partial extension to the parenchyma. Testicular microlithiasis is a rare finding. Moreover, the pediatric cases reported in the literature are very few. However, the use of high-frequency US transducers (10–13 MHz) has recently allowed an easier demonstration of this disease also in children. Of particular interest is the study of the still-debated association of microliths with other diseases such as neoplasms. Some aspects need further investigation, namely the real incidence of microliths in the healthy population, the incidence of tumors in patients with microliths, the differences between adults and children, and the different types of follow-up at different ages. In pediatric age, if TM represents an isolated sign, patients need non-invasive US follow-up until adult age. Only if TM is in association with focal lesions of testis parenchyma is it mandatory to perform biopsy or surgical treatment.

Gastric duplication cyst: appearance on prenatal US and MRI

M. Lituania Department of Obstetrics and Gynaecology, Giannina Gaslini Hospital for Sick Children, Genoa, Italy Gastric duplication cyst (GDC) is a rare malformation of the gastrointestinal tract. Only seven cases detected by prenatal US have been described to date [1]. Routine US of a 29-year-old gravida at 24 weeks’ gestation detected an 8-mm cyst adjacent to the fetal stomach (Fig. 1). A presumptive diagnosis of GDC was made. However, the rarity and uncertainty of the prenatal US findings prompted us to undertake prenatal MRI to define better the cyst origin and relationship with adjacent organs. Turbo spinecho express T2-weighted sequences were used and showed a round, well-circumscribed, hyperintense 1-cm mass below the diaphragm and adherent to the gastro-oesophageal junction. The other abdominal organs appeared to be normal (Fig. 2). On day 10, after delivery at term, the baby underwent laparotomy. A GDC connected to the cardia was resected. To the best of our knowledge, this is the first prenatal MRI detection of GDC. In our case, prenatal MRI confirmed the presumptive US diagnosis, providing additional information on the malformation site and the nature and relationship with other organs, thus contributing to treatment planning.

Pyloric atresia: report of two cases (one associated with epidermolysis bullosa and one associated with multiple intestinal atresias)

Abstract. We describe the US findings in two vomiting newborns affected by different forms of pyloric atresia, a rare congenital anomaly that includes a spectrum of lesions limited to the antro-pyloric region of the stomach and with various inheritance mechanisms and syndromic associations.

Eosinophilic chromophobe renal cell carcinoma in a child with hypospadias

Chromophobe renal cell carcinoma (CRCC) is a distinct variant of renal carcinoma generally affecting adults. We report a case of an unusual CRCC, arising in a male child affected by hypospadias. This case demonstrates that CRCC can occur in the pediatric patients and can be associated with genital tract anomalies such as Wilms tumor. Pediatr Blood Cancer 2008;50:413–415.