Gian Luigi Natali

Congenital Askin tumor with favorable outcome: case report and review of the literature ☆

Several disorders may present as cystic complex lesions of the fetal thorax, both with benign and malignant behavior. As a consequence, their detection may pose diagnostic, therapeutic, and parental counseling dilemmas. We describe a neonate with a congenital Askin tumor, diagnosed at the 37th week of gestation and treated after birth. Counseling and treatment challenges are discussed.

Sclerotherapy of primary aneurysmal bone cysts: comment to Lambot-Juhan et al.

Sir, We read with great interest the article by Lambot-Juhan et al. [1] titled “Primary aneurysmal bone cysts in children: percutaneous sclerotherapy with absolute alcohol and proposal of a vascular classification.” We agree that alcohol can be safely used for percutaneous treatment of primary aneurysmal bone cysts, and we have performed this procedure for simple bone cysts nonresponsive to local corticosteroid injection since alcoholic zein solution (Ethibloc, Ethnor Laboratories/Ethicon, Norderstedt, Germany) was retracted from the market. However, we hereby respectfully express our reservations regarding some points in the manuscript: & Performance of an open biopsy of aneurysmal bone cysts before percutaneous sclerotherapy might not correspond to the criteria of a minimally invasive procedure [2]. Biopsy of the cyst might be obtained with a percutaneous procedure as well, using biopsy forceps introduced under fluoroscopic guidance through an 11-G bone biopsy needle, in order to obtain multiple specimens from the cyst wall. & Differential diagnosis between aneurysmal bone cysts and simple bone cysts (unicameral bone cysts in the Campanacci classification) [3] may also be done with MRI. In this respect a fluid level within the cyst, secondary to gross blood contained, may be demonstrated in aneurysmal bone cysts and may be absent in simple bone cysts [4, 5]. However, a fluid level discovered in a cystic bone lesion may also be related to a telangiectatic sarcoma, a highly malignant neoplasm with different prognostic and therapeutic features [6, 7]. For that reason, a histological definition of the lesion with adequate sampling before treatment is necessary. & Venous escapes from the cysts are often noted during contrast injection before sclerotherapy and their presence may be related to both the pressure and the volume of contrast material injected during the procedure, especially when the injection is performed with a single needle inserted into the cyst. & The role of MRI in follow-up studies after treatment must be emphasized, especially for patients such as infants and adolescents who can undergo the exam without sedation or anesthesia [4, 5]. Furthermore, the sensitivity of MRI is higher when compared to conventional radiographic study for the detection of recurrence of the aneurysmal bone cysts (blood-filled spaces, fluid levels) [4, 5], thus orientating physicians to other treatments. A. Crocoli (*) Department of Surgery and Transplantation, Division of General Surgery, Bambino Gesù Children Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy e-mail: alessandro.crocoli@opbg.net

Successful percutaneous transhepatic recanalization of a completely obstructed hepatico‐jejunal anastomosis in a child with liver transplantation: Unusual employment of the transseptal puncture system

Stenosis of the HJ is a common complication of pediatric split LT with high morbidity and possible evolution to secondary biliary cirrhosis and re‐transplantation if not treated. Because the endoscopy is generally infeasible in the Roux‐en‐Y, percutaneous interventional radiology management is usually the safest and most effective approach to avoid surgical revision of a stenotic bilio‐enteric anastomosis. We present the case of a child with acute onset of cholestasis 7 months after left lateral segment partial LT due to occlusion of the HJ. The biliary stricture was found to be non‐crossable with conventional interventional radiological techniques. The obstruction was resolved creating a new bilio‐digestive communication via percutaneous transhepatic approach using the TPS. This device is usually employed by the interventional cardiologist to perform some procedures requiring the direct access to the left atrium through interatrial septal puncture. In conclusion, percutaneous transhepatic recanalization of the hepato‐jejuno anastomosis is a rare but feasible and valuable procedure alternative to the surgical resolution even in small infants. Although few cases have been reported in literature, it has to be considered an additional treatment option when the conventional approaches fail.