Pub Date : 2026-03-01Epub Date: 2026-01-02DOI: 10.1016/j.epsc.2026.103170
Sweta Rose , Kamal Nain Rattan , Shivani Malik
Background
Hepatic mesenchymal tumor is a rare benign pediatric hepatic tumor, typically presenting in children less than 2 years of age. Although it has a variable imaging appearance, and favorable prognosis if diagnosed and managed correctly.
Case presentation
A 3-year-old male patient presented with abdominal distension, a large abdominal mass with rapid evolution over four weeks, and poor weight gain. His family and medical history were unremarkable. Imaging studies revealed a large solid-cystic mass arising from the left lobe of the liver. Laboratory parameters were within normal limits. He underwent exploratory laparotomy; careful dissection was undertaken to mobilize the left lobe. The left hepatic artery, portal vein, and left hepatic duct were meticulously isolated and controlled. The tumor was removed intact while preserving the surrounding liver parenchyma. Macroscopic and histological examination described an 18 × 13 × 6 cm multicystic mass consistent with mesenchymal hamartoma of the liver (MHL). The patient remains well at 5-month follow-up, with no evidence of lesion recurrence.
Conclusion
Mesenchymal hamartoma should be included in the differential diagnosis of hepatic masses in children. Complete resection is curative.
{"title":"Pedunculated mesenchymal hamartoma of the left lobe of liver in a 3-year-old child: a case report","authors":"Sweta Rose , Kamal Nain Rattan , Shivani Malik","doi":"10.1016/j.epsc.2026.103170","DOIUrl":"10.1016/j.epsc.2026.103170","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic mesenchymal tumor is a rare benign pediatric hepatic tumor, typically presenting in children less than 2 years of age. Although it has a variable imaging appearance, and favorable prognosis if diagnosed and managed correctly.</div></div><div><h3>Case presentation</h3><div>A 3-year-old male patient presented with abdominal distension, a large abdominal mass with rapid evolution over four weeks, and poor weight gain. His family and medical history were unremarkable. Imaging studies revealed a large solid-cystic mass arising from the left lobe of the liver. Laboratory parameters were within normal limits. He underwent exploratory laparotomy; careful dissection was undertaken to mobilize the left lobe. The left hepatic artery, portal vein, and left hepatic duct were meticulously isolated and controlled. The tumor was removed intact while preserving the surrounding liver parenchyma. Macroscopic and histological examination described an 18 × 13 × 6 cm multicystic mass consistent with mesenchymal hamartoma of the liver (MHL). The patient remains well at 5-month follow-up, with no evidence of lesion recurrence.</div></div><div><h3>Conclusion</h3><div>Mesenchymal hamartoma should be included in the differential diagnosis of hepatic masses in children. Complete resection is curative.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"126 ","pages":"Article 103170"},"PeriodicalIF":0.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-13DOI: 10.1016/j.epsc.2026.103180
Pooya Ganjali , Douglas Tamura , Stephanie Jones
Introduction
Robotic-assisted thoracic surgery in the management of pleuropulmonary blastoma (PPB) remains extremely rare.
Case presentation
A 12-year-old female with a known heterozygous DICER-1 mutation developed mild chest pain. She had a history of multifocal follicular thyroid carcinoma and a history of a small cystic lesion in the upper lobe of the left lung, measuring 3.0 × 4 × 4 cm. The cyst had been stable in size for several years. At the time of presentation, she underwent a chest computerized tomography (CT) that showed that the cyst had increased in size to 14 × 8 × 8.6 cm and had new calcifications. We took her to the operating room for an exploratory thoracoscopy. We initially drained the cyst with a thoracoscopic needle. Once the cyst was decompressed, we added 2 ports, docked the DaVinci ® robotic device, and did a robotic-assisted wedge resection on the upper lobe. The specimen was placed in a bag before removing it from the chest. The pathology analysis confirmed the diagnosis of PPB Type II and confirmed clear margins. We left a chest tube, which was removed 36 hours later. Post-operative imaging showed no residual tumor. The oncology service recommended no additional surgical resection. She was enrolled in a therapeutic trial and is currently receiving adjuvant chemotherapy and radiotherapy.
Conclusion
Robotic-assisted thoracoscopy may be a safe and effective approach for the management of type II PPB.
{"title":"Robotic-assisted thoracoscopy in the treatment of pleuropulmonary blastoma: A case report","authors":"Pooya Ganjali , Douglas Tamura , Stephanie Jones","doi":"10.1016/j.epsc.2026.103180","DOIUrl":"10.1016/j.epsc.2026.103180","url":null,"abstract":"<div><h3>Introduction</h3><div>Robotic-assisted thoracic surgery in the management of pleuropulmonary blastoma (PPB) remains extremely rare.</div></div><div><h3>Case presentation</h3><div>A 12-year-old female with a known heterozygous DICER-1 mutation developed mild chest pain. She had a history of multifocal follicular thyroid carcinoma and a history of a small cystic lesion in the upper lobe of the left lung, measuring 3.0 × 4 × 4 cm. The cyst had been stable in size for several years. At the time of presentation, she underwent a chest computerized tomography (CT) that showed that the cyst had increased in size to 14 × 8 × 8.6 cm and had new calcifications. We took her to the operating room for an exploratory thoracoscopy. We initially drained the cyst with a thoracoscopic needle. Once the cyst was decompressed, we added 2 ports, docked the DaVinci ® robotic device, and did a robotic-assisted wedge resection on the upper lobe. The specimen was placed in a bag before removing it from the chest. The pathology analysis confirmed the diagnosis of PPB Type II and confirmed clear margins. We left a chest tube, which was removed 36 hours later. Post-operative imaging showed no residual tumor. The oncology service recommended no additional surgical resection. She was enrolled in a therapeutic trial and is currently receiving adjuvant chemotherapy and radiotherapy.</div></div><div><h3>Conclusion</h3><div>Robotic-assisted thoracoscopy may be a safe and effective approach for the management of type II PPB.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"126 ","pages":"Article 103180"},"PeriodicalIF":0.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.epsc.2026.103184
John Paul Bustamante , Shaban Gheith , Mohammad Fadaie , Brandon Velazquez , Jill Menell , Colin Bethel
Introduction
Primary ovarian mucinous adenocarcinoma in the adolescent population is extremely rare, with limited cases reported in the literature.
Case presentation
A 14-year-old female presented with a two-week history of progressive abdominal pain, distension, bloating, early satiety, and fatigue. Physical examination revealed a significantly distended abdomen with diffuse tenderness. Contrast-enhanced CT imaging demonstrated a large multiloculated cystic adnexal mass measuring 36 × 32 × 21 cm, with displacement of bowel loops. Laboratory evaluation showed normal tumor markers except for a mildly elevated CA-125 of 47 U/mL (reference range: <35 U/mL). The patient initially underwent diagnostic laparoscopy, which was converted to open laparotomy due to the tumor's size and complexity. Replacing the left ovary, a unilateral, encapsulated mucinous tumor was entirely excised along with the associated incorporated left ovary and fallopian tube, with preservation of the uterus and contralateral adnexa. Histopathology demonstrated mucinous cystadenoma (70 %), borderline tumor (25 %), and a focal invasive mucinous adenocarcinoma component (<5 %), without lymphovascular or infiltrative invasion. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Upon follow up, she continued to have elevated CA-125 of 56 U/mL, and underwent staging laparoscopy, noted to be negative for any metastatic disease, repeat CA-125 normalized 13 U/mL. Long term planned follow up with routine ultrasounds and CA-125 levels.
Conclusion
Mucinous ovarian tumors can have borderline and malignant components and therefore require a thorough histopathologic analysis.
{"title":"Ovarian mucinous adenoma with a malignant component in an adolescent: a case report","authors":"John Paul Bustamante , Shaban Gheith , Mohammad Fadaie , Brandon Velazquez , Jill Menell , Colin Bethel","doi":"10.1016/j.epsc.2026.103184","DOIUrl":"10.1016/j.epsc.2026.103184","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary ovarian mucinous adenocarcinoma in the adolescent population is extremely rare, with limited cases reported in the literature.</div></div><div><h3>Case presentation</h3><div>A 14-year-old female presented with a two-week history of progressive abdominal pain, distension, bloating, early satiety, and fatigue. Physical examination revealed a significantly distended abdomen with diffuse tenderness. Contrast-enhanced CT imaging demonstrated a large multiloculated cystic adnexal mass measuring 36 × 32 × 21 cm, with displacement of bowel loops. Laboratory evaluation showed normal tumor markers except for a mildly elevated CA-125 of 47 U/mL (reference range: <35 U/mL). The patient initially underwent diagnostic laparoscopy, which was converted to open laparotomy due to the tumor's size and complexity. Replacing the left ovary, a unilateral, encapsulated mucinous tumor was entirely excised along with the associated incorporated left ovary and fallopian tube, with preservation of the uterus and contralateral adnexa. Histopathology demonstrated mucinous cystadenoma (70 %), borderline tumor (25 %), and a focal invasive mucinous adenocarcinoma component (<5 %), without lymphovascular or infiltrative invasion. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Upon follow up, she continued to have elevated CA-125 of 56 U/mL, and underwent staging laparoscopy, noted to be negative for any metastatic disease, repeat CA-125 normalized 13 U/mL. Long term planned follow up with routine ultrasounds and CA-125 levels.</div></div><div><h3>Conclusion</h3><div>Mucinous ovarian tumors can have borderline and malignant components and therefore require a thorough histopathologic analysis.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"126 ","pages":"Article 103184"},"PeriodicalIF":0.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-02DOI: 10.1016/j.epsc.2026.103172
Jennifer Osher , Caleb Brown , Mary Morgan Barron , Ismael Kaitama , Patrick Costello , Andrew Trecartin
Introduction
Ovarian fibromas are rare in children, and cellular fibromas with mitotic activity are exceptionally uncommon, with fewer than ten pediatric cases reported. Their preoperative differentiation from malignant tumors is challenging.
Case presentation
We report a 14-month-old girl who was hospitalized for malarial fevers in addition to an abdominal mass. She had a prior two-month history of painless abdominal distention with a palpable, non-tender lower abdominal mass. The patient had mild anemia (hemoglobin of 11.2 g/dl). Tumor markers were unavailable. Ultrasound demonstrated an 8 × 5 cm solid pelvic mass. The mass was well circumscribed with a homogeneous echotexture. Laparotomy revealed no evidence of metastatic disease, and the contralateral ovary was normal. A solid tumor of the right ovary without visible normal ovarian stroma was identified. The highly vascular tumor capsule was adherent to the right fallopian tube, which was carefully separated and preserved. The bisected tumor was notable for pale tan homogeneous tissue within the tumor capsule. Histopathology demonstrated a cellular fibroma with focal necrosis and rare mitoses. The patient was tolerating a regular diet and ambulating well within 24 hours postoperatively. Her one-week follow-up visit confirmed no complications. The family was instructed to follow up annually, with plans for serial abdominal ultrasounds and chest radiographs.
Conclusion
As benign ovarian tumors such as cellular fibroma can occur in females as young as one year of age, in the absence of a definitive preoperative diagnosis of malignancy surgeons should prioritize fertility preservation over radical salpingo-oophorectomy.
{"title":"Ovarian fibroma in a 14-month-old girl: A case report","authors":"Jennifer Osher , Caleb Brown , Mary Morgan Barron , Ismael Kaitama , Patrick Costello , Andrew Trecartin","doi":"10.1016/j.epsc.2026.103172","DOIUrl":"10.1016/j.epsc.2026.103172","url":null,"abstract":"<div><h3>Introduction</h3><div>Ovarian fibromas are rare in children, and cellular fibromas with mitotic activity are exceptionally uncommon, with fewer than ten pediatric cases reported. Their preoperative differentiation from malignant tumors is challenging.</div></div><div><h3>Case presentation</h3><div>We report a 14-month-old girl who was hospitalized for malarial fevers in addition to an abdominal mass. She had a prior two-month history of painless abdominal distention with a palpable, non-tender lower abdominal mass. The patient had mild anemia (hemoglobin of 11.2 g/dl). Tumor markers were unavailable. Ultrasound demonstrated an 8 × 5 cm solid pelvic mass. The mass was well circumscribed with a homogeneous echotexture. Laparotomy revealed no evidence of metastatic disease, and the contralateral ovary was normal. A solid tumor of the right ovary without visible normal ovarian stroma was identified. The highly vascular tumor capsule was adherent to the right fallopian tube, which was carefully separated and preserved. The bisected tumor was notable for pale tan homogeneous tissue within the tumor capsule. Histopathology demonstrated a cellular fibroma with focal necrosis and rare mitoses. The patient was tolerating a regular diet and ambulating well within 24 hours postoperatively. Her one-week follow-up visit confirmed no complications. The family was instructed to follow up annually, with plans for serial abdominal ultrasounds and chest radiographs.</div></div><div><h3>Conclusion</h3><div>As benign ovarian tumors such as cellular fibroma can occur in females as young as one year of age, in the absence of a definitive preoperative diagnosis of malignancy surgeons should prioritize fertility preservation over radical salpingo-oophorectomy.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"126 ","pages":"Article 103172"},"PeriodicalIF":0.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.epsc.2025.103162
Jayne Rice , Lily Huang , Peter Abt , Alexander Fairman
Introduction
There are numerous surgical techniques used for revascularization in the setting of renal artery stenosis in children, although formal guidelines do not exist and “standard of care” is dictated by center experience.
Case presentation
We present a case of a 7-year-old male with multi-drug-resistant hypertension in the setting of complex renal artery anatomy. His genetic testing was unrevealing for congenital aortopathies, and his clinical history was not suggestive of vasculitis or other inflammatory conditions. Computerized tomography angiogram (CTA) demonstrated two main renal arteries on the right, both with high grade, proximal stenosis, and on the left his main renal artery was occluded, with robust collateral filling. Nuclear function testing of the left kidney demonstrated <10 % function. The patient initially underwent an aorto-renal bypass using hypogastric artery; however, the bypass became occluded on post operative day four. To salvage the kidney, the patient underwent an auto-transplantation into the pelvis using a syndactylization technique to salvage both right renal arteries. He recovered well and is slowly weaning his anti-hypertensives at his last visit, 9 months post-operative.
Conclusion
Auto-transplantation can be a useful method to surgically manage complex renal artery stenosis, and salvage failed prior repairs.
{"title":"Kidney auto-transplantation in a 7-year-old with complex renal artery anatomy and multi-drug-resistant hypertension: a case report","authors":"Jayne Rice , Lily Huang , Peter Abt , Alexander Fairman","doi":"10.1016/j.epsc.2025.103162","DOIUrl":"10.1016/j.epsc.2025.103162","url":null,"abstract":"<div><h3>Introduction</h3><div>There are numerous surgical techniques used for revascularization in the setting of renal artery stenosis in children, although formal guidelines do not exist and “standard of care” is dictated by center experience.</div></div><div><h3>Case presentation</h3><div>We present a case of a 7-year-old male with multi-drug-resistant hypertension in the setting of complex renal artery anatomy. His genetic testing was unrevealing for congenital aortopathies, and his clinical history was not suggestive of vasculitis or other inflammatory conditions. Computerized tomography angiogram (CTA) demonstrated two main renal arteries on the right, both with high grade, proximal stenosis, and on the left his main renal artery was occluded, with robust collateral filling. Nuclear function testing of the left kidney demonstrated <10 % function. The patient initially underwent an aorto-renal bypass using hypogastric artery; however, the bypass became occluded on post operative day four. To salvage the kidney, the patient underwent an auto-transplantation into the pelvis using a syndactylization technique to salvage both right renal arteries. He recovered well and is slowly weaning his anti-hypertensives at his last visit, 9 months post-operative.</div></div><div><h3>Conclusion</h3><div>Auto-transplantation can be a useful method to surgically manage complex renal artery stenosis, and salvage failed prior repairs.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"125 ","pages":"Article 103162"},"PeriodicalIF":0.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-17DOI: 10.1016/j.epsc.2025.103164
Mary R. Foster , Hyunyoung G. Kim , John J. Doski
Background
Mediastinal lymphangiomas are rare benign congenital malformations of the lymphatic system in children, often presenting with non-specific respiratory symptoms and posing diagnostic challenges.
Case presentation
A previously healthy 4-year-old female presented with progressive chest pain and intermittent dyspnea. Imaging revealed a large multiloculated cystic lesion (9.6 × 7.3 × 10.8 cm) occupying much of the right hemithorax, causing leftward mediastinal shift and compression of adjacent structures. Thoracentesis and right pigtail thoracostomy yielded partial drainage but incomplete resolution. Workup for Echinococcus, Histoplasma, Coccidioides, and tuberculosis was negative. Cyst fluid and blood cultures showed no growth, while cytology of the cyst fluid demonstrated inflammatory cells without evidence of malignancy. She was treated empirically with intravenous antibiotics for presumed obstructive pneumonia. On hospital day 8, she underwent right thoracotomy with complete excision of the multiloculated cystic mass, which was adherent to but separate from the pericardium and lung. There was no lymphatic leak, and the intraoperative chest tube was removed on postoperative day 2. Histopathology confirmed a benign cystic lymphangioma. The patient was discharged on hospital day 11 and remained asymptomatic and recurrence-free at 1-year follow-up.
Conclusion
Mediastinal lymphangioma should be considered in the differential diagnosis of pediatric patients presenting with progressive respiratory symptoms or cystic mediastinal lesions on imaging.
{"title":"Giant mediastinal lymphangioma in a 4-year-old girl: a case report","authors":"Mary R. Foster , Hyunyoung G. Kim , John J. Doski","doi":"10.1016/j.epsc.2025.103164","DOIUrl":"10.1016/j.epsc.2025.103164","url":null,"abstract":"<div><h3>Background</h3><div>Mediastinal lymphangiomas are rare benign congenital malformations of the lymphatic system in children, often presenting with non-specific respiratory symptoms and posing diagnostic challenges.</div></div><div><h3>Case presentation</h3><div>A previously healthy 4-year-old female presented with progressive chest pain and intermittent dyspnea. Imaging revealed a large multiloculated cystic lesion (9.6 × 7.3 × 10.8 cm) occupying much of the right hemithorax, causing leftward mediastinal shift and compression of adjacent structures. Thoracentesis and right pigtail thoracostomy yielded partial drainage but incomplete resolution. Workup for <em>Echinococcus</em>, <em>Histoplasma</em>, <em>Coccidioides</em>, and tuberculosis was negative. Cyst fluid and blood cultures showed no growth, while cytology of the cyst fluid demonstrated inflammatory cells without evidence of malignancy. She was treated empirically with intravenous antibiotics for presumed obstructive pneumonia. On hospital day 8, she underwent right thoracotomy with complete excision of the multiloculated cystic mass, which was adherent to but separate from the pericardium and lung. There was no lymphatic leak, and the intraoperative chest tube was removed on postoperative day 2. Histopathology confirmed a benign cystic lymphangioma. The patient was discharged on hospital day 11 and remained asymptomatic and recurrence-free at 1-year follow-up.</div></div><div><h3>Conclusion</h3><div>Mediastinal lymphangioma should be considered in the differential diagnosis of pediatric patients presenting with progressive respiratory symptoms or cystic mediastinal lesions on imaging.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"125 ","pages":"Article 103164"},"PeriodicalIF":0.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heteropagus (parasitic) twinning is an exceptionally rare congenital anomaly characterized by an incompletely formed parasitic twin attached to a more developed autosite. We present the first case series from our region, illustrating unusual anatomical variants and complex visceral associations seldom reported in the literature.
Case presentation
Over the last two decades, 4 newborns with heteropagus twinning were surgically managed. The first patient was a full-term newborn with a well-developed third lower limb implanted in the right iliac region and a rudimentary upper limb attached above the pubis. Both additional limbs were excised successfully with an uneventful recovery. The second patient presented with duplicated genitalia, double bladder, colonic duplication, patent ductus arteriosus and a ventricular septal defect). Complete surgical correction led to a favorable long-term outcome. The third patient had a gluteal parasitic limb associated with a sacrococcygeal teratoma, renal dysplasia, and genital duplication. He died on day of life 11 from cardiorespiratory failure before any resection was attempted. The fourth patient had an epigastric parasitic twin with a large omphalocele containing rudimentary intestine. Separation was completed at one month of age, but the patient died on the first postoperative day.
Conclusion
Heteropagus (parasitic) twinning can present with multiple phenotypic variants. Visceral and particularly cardiac malformations play a key prognostic role.
{"title":"Heteropagus twins: A case series","authors":"Martial Olivier Moulot , Jean Marie Konan , Agnime Reine - Christine Akproh , Julie Konan , Manuela Adjoba Ehua , Kouamé Soroboua Agbara","doi":"10.1016/j.epsc.2025.103165","DOIUrl":"10.1016/j.epsc.2025.103165","url":null,"abstract":"<div><h3>Introduction</h3><div>Heteropagus (parasitic) twinning is an exceptionally rare congenital anomaly characterized by an incompletely formed parasitic twin attached to a more developed autosite. We present the first case series from our region, illustrating unusual anatomical variants and complex visceral associations seldom reported in the literature.</div></div><div><h3>Case presentation</h3><div>Over the last two decades, 4 newborns with heteropagus twinning were surgically managed. The first patient was a full-term newborn with a well-developed third lower limb implanted in the right iliac region and a rudimentary upper limb attached above the pubis. Both additional limbs were excised successfully with an uneventful recovery. The second patient presented with duplicated genitalia, double bladder, colonic duplication, patent ductus arteriosus and a ventricular septal defect). Complete surgical correction led to a favorable long-term outcome. The third patient had a gluteal parasitic limb associated with a sacrococcygeal teratoma, renal dysplasia, and genital duplication. He died on day of life 11 from cardiorespiratory failure before any resection was attempted. The fourth patient had an epigastric parasitic twin with a large omphalocele containing rudimentary intestine. Separation was completed at one month of age, but the patient died on the first postoperative day.</div></div><div><h3>Conclusion</h3><div>Heteropagus (parasitic) twinning can present with multiple phenotypic variants. Visceral and particularly cardiac malformations play a key prognostic role.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"125 ","pages":"Article 103165"},"PeriodicalIF":0.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although rhabdomyosarcoma (RMS) is the most common soft-tissue neoplasm in children, primary breast rhabdomyosarcoma is rare, as breast involvement typically occurs through secondary metastasis rather than as a primary tumor.
Case presentation
A 14-year-old girl presented with a progressively enlarging swelling in her left breast over eight weeks. It began as a small, peanut-sized lump that gradually increased in size, followed six weeks later by a left axillary swelling. She sought medical care eight weeks after the breast swelling began. At presentation, she reported fatigue, weight loss, loss of appetite, and night sweats.
On examination, she was malnourished (BMI 18.1 kg/m2). A firm, non-tender left breast mass measuring 5 × 4 cm was palpated, fixed to underlying tissue but not adherent to the skin. A hard, non-tender left axillary lymph node measuring 2 × 1.5 cm was also noted, while the right breast and axilla were normal.
Ultrasound and fine-needle aspiration cytology (FNAC) revealed an undifferentiated high-grade malignant tumor with axillary metastasis. Given lymphatic spread, the disease was considered advanced, and chemotherapy with Adriamycin and cyclophosphamide was initiated.
Because other malignancies such as high-grade non-Hodgkin lymphoma and dysgerminoma were possible, an incisional biopsy was performed before mastectomy. Histopathology showed small round blue cells, and immunohistochemistry confirmed rhabdomyosarcoma.
After diagnosis, the prognosis and treatment options, including radical mastectomy with lymph node dissection, were discussed with the patient and her family. However, they declined surgery and continued chemotherapy alone.
One month later, she returned for her second chemotherapy cycle but had developed back pain and severe debilitation. She did not return afterward and passed away two months later.
Conclusion
Breast rhabdomyosarcoma should be considered in the differential diagnosis of unexplained or rapidly enlarging breast swelling, particularly in young patients.
{"title":"Primary rhabdomyosarcoma of the breast in a teenager: a case report","authors":"Wondwosen Mengist Dereje , Emebet Hunie Baze , Asya Mohammed Yesuf , Atsede Abebe , Yohannes Leweyehu Debasu , Eyoel Negash Taddesse","doi":"10.1016/j.epsc.2025.103158","DOIUrl":"10.1016/j.epsc.2025.103158","url":null,"abstract":"<div><h3>Introduction</h3><div>Although rhabdomyosarcoma (RMS) is the most common soft-tissue neoplasm in children, primary breast rhabdomyosarcoma is rare, as breast involvement typically occurs through secondary metastasis rather than as a primary tumor.</div></div><div><h3>Case presentation</h3><div>A 14-year-old girl presented with a progressively enlarging swelling in her left breast over eight weeks. It began as a small, peanut-sized lump that gradually increased in size, followed six weeks later by a left axillary swelling. She sought medical care eight weeks after the breast swelling began. At presentation, she reported fatigue, weight loss, loss of appetite, and night sweats.</div><div>On examination, she was malnourished (BMI 18.1 kg/m<sup>2</sup>). A firm, non-tender left breast mass measuring 5 × 4 cm was palpated, fixed to underlying tissue but not adherent to the skin. A hard, non-tender left axillary lymph node measuring 2 × 1.5 cm was also noted, while the right breast and axilla were normal.</div><div>Ultrasound and fine-needle aspiration cytology (FNAC) revealed an undifferentiated high-grade malignant tumor with axillary metastasis. Given lymphatic spread, the disease was considered advanced, and chemotherapy with Adriamycin and cyclophosphamide was initiated.</div><div>Because other malignancies such as high-grade non-Hodgkin lymphoma and dysgerminoma were possible, an incisional biopsy was performed before mastectomy. Histopathology showed small round blue cells, and immunohistochemistry confirmed rhabdomyosarcoma.</div><div>After diagnosis, the prognosis and treatment options, including radical mastectomy with lymph node dissection, were discussed with the patient and her family. However, they declined surgery and continued chemotherapy alone.</div><div>One month later, she returned for her second chemotherapy cycle but had developed back pain and severe debilitation. She did not return afterward and passed away two months later.</div></div><div><h3>Conclusion</h3><div>Breast rhabdomyosarcoma should be considered in the differential diagnosis of unexplained or rapidly enlarging breast swelling, particularly in young patients.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"125 ","pages":"Article 103158"},"PeriodicalIF":0.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145705723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-18DOI: 10.1016/j.epsc.2025.103166
Rayan A. Rahmani , Johanna M. Borst , David F. Grabski , Amir M. Alhajjat , Mehul V. Raval
Introduction
Extralobar pulmonary sequestration (EPS) has been reported in intradiaphragmatic or intraabdominal locations, but simultaneous involvement of multiple compartments is exceedingly rare. This is the first reported case to our knowledge with simultaneous intrathoracic, transdiaphragmatic, and gastric involvement.
Case presentation
A 21-month-old male was prenatally diagnosed with a left lung lesion via ultrasound. A computed tomography (CT) scan with contrast performed at 3 months of age at an outside center was consistent with a left lower lobe hybrid lesion. The family did not wish to undergo surgery at that time. A repeat CT scan with contrast was performed at 15 months of age for better visualization of the anatomy. The patient underwent video-assisted thoracoscopic surgery, which revealed an extrapulmonary mass with feeding vessels from the aorta and a fibrous transdiaphragmatic connection to the stomach. Intraoperative upper endoscopy confirmed no esophageal or gastric luminal involvement. The lesion was resected, and the diaphragm was primarily closed thoracoscopically. Pathology demonstrated extrapulmonary sequestration with type 2 congenital pulmonary airway malformation (CPAM)-like features. The patient recovered well and was discharged on postoperative day two.
Conclusion
Congenital lung lesions may have transdiaphragmatic extensions to the digestive tract not detectable by preoperative imaging studies.
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Pub Date : 2026-02-01Epub Date: 2025-12-24DOI: 10.1016/j.epsc.2025.103168
Daniel Lamb , Christopher Huffman , Dan Parrish
Introduction
Tension viscerothorax is an infrequent but potentially deadly complication of traumatic diaphragmatic rupture. Abdominal organ herniation into the thoracic cavity results in increased intrathoracic pressure, thus mimicking a tension pneumothorax with subsequent physiological derangements.
Case presentation
A 15-year-old female was medevacked to our hospital after sustaining significant blunt thoracoabdominal trauma secondary to a high-speed Motor vehicle crash (MVC). On arrival the patient was hemodynamically unstable and hypoxic despite being endotracheal intubation (ETT) intubated with ongoing bag valve mask (BVM) ventilation. A left thoracostomy was emergently performed, oxygen saturations improved momentarily thereafter. Exam revealed a prominent seatbelt sign and left thoracoabdominal bruising with abrasions. Computer tomography (CT) of the chest, abdomen and pelvis revealed a left traumatic diaphragmatic rupture, left hemothorax with mediastinal shift, grade 2 splenic laceration, grade 3 left kidney laceration, grade 2 left liver lobe laceration, grade 1–2 pancreatic injury, and an unstable L1-L2 flexion injury concerning for possible spinal cord injury, along with a comminuted left scapular fracture. The patient was taken for an emergent left anterior thoracotomy, revealing omentum, stomach, and spleen within the left thoracic cavity obscuring the diaphragmatic injury. A midline laparotomy was performed, to allow visualization and repair of the diaphragm which revealed transected jejunum. A temporary abdominal closure system was placed. Two days later she returned for washout with anastomosis. The patient ultimately underwent additional orthopedic surgeries, along with a prolonged hospitalization including rehabilitation but was ultimately discharged home.
Conclusion
Tension viscerothorax must be considered in children who sustain severe blunt thoracoabdominal trauma, as it can cause life-threatening physiological derangements.
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