Trichobezoar as the underlying cause of an epigastric mass in an adolescent patient

Trichobezoar (hairball) is a foreign body typically located in the stomach, which is a collection of hair pulled out and swallowed as a result of trichotillomania and trichophagia. Its presentation usually lacks specificity, the exact constellation of symptoms correlating to the hairball’s precise location and size. The most frequent signs include epigastric pain, flatulence, nausea, bloating, dysphagia, satiety, loss of weight and halitosis. We report a case of a female patient with abdominal pain and nausea initially misdiagnosed as intestinal infestation, and subsequently, for several years, as gastroesophageal reflux. Physical examination disclosed an epigastric mass. Imaging examinations demonstrated a bezoar, and the patient was successfully treated by means of surgical extraction. The differential diagnosis of gastrointestinal symptoms, especially in young females, should account for trichotillophagia, hence the need to enquire after compulsive disorders when taking patient history. Successful removal of a trichobezoar should be followed by psychotherapy to prevent recurrence of symptoms.Trichobezoar to ciało lokalizujące się głównie w żołądku, złożone m.in. z włosów połkniętych w wyniku trichotillomanii i trichotillofagii. Objawy są zwykle niespecyficzne, zależne od lokalizacji i wielkości trichobezoaru. Zazwyczaj obserwuje się bóle w nadbrzuszu, wzdęcia, nudności, wymioty, uczucie pełności w jamie brzusznej, zaburzenia połykania, utratę łaknienia, ubytek masy ciała i nieprzyjemny zapach z ust. W artykule przedstawiono przypadek dziewczynki, u której bóle brzucha i nudności były mylnie interpretowane jako infestacja jelitowa, a następnie, przez kilka lat, jako refluks żołądkowo-przełykowy. Stwierdzono guz w nadbrzuszu, który w badaniach obrazowych wskazywał na istnienie bezoaru, po czym usunięto go chirurgicznie z dobrym efektem. W diagnostyce objawów gastroenterologicznych trzeba brać pod uwagę, zwłaszcza u dziewczynek i młodych kobiet, możliwość trichotillofagii – ważne jest więc rozszerzenie wywiadu lekarskiego o pytania dotyczące zachowań kompulsywnych. Po leczeniu należy objąć pacjentkę psychoterapią w celu zapobieżenia nawrotom

Abdominal germ cell tumors in children : report of two cases

Background: Abdominal germ cell tumors are neoplasms which originate from the primary germ cells. Diagnostic imaging (US, CT and MRI) can detect and localize the tumor as well as show its structure. We present two cases of germ cell tumors, which, despite very good imaging in sonography and CT, caused problems in final diagnosis. Case report: In a boy, a polycyclic tumor of the liver hilus was detected. In a girl, two tumors in the pelvis and a few others in the retroperitoneal space were detected. Lymphoma, neuroblastoma and PNET tumors were included in the differential diagnosis. In case of clinical suspicion of an abdominal tumor, including germ cell tumors, diagnostic imaging should begin with sonography. Conclusions: Replacing CT, which is not charged with ionizing radiation, with MRI, especially in monitoring of the treatment effects, should be considered. The ultimate diagnosis of the tumor type must be established on the basis of histopathological examination

Ocena przydatności badań obrazowych (RTG, TK, MR) w diagnostyce mięsaka Ewinga u dzieci : doświadczenia własne

Background: Ewing sarcoma is a malignant, small round cell bone tumor, presenting predominantly in children and adolescents. Ewing sarcoma may develop in every bone; diaphyses of long bones, ribs and flat bones are the main locations. Local and systemic clinical symptoms are nonspecific - pain, swelling, fever or ill-being. The aim of the study was to assess the role of radiography, computed tomography and magnetic resonance imaging in the analysis of bone lesions in children and young adults with Ewing sarcoma. Material/Methods: Twenty-seven patients, aged between 1 year and 10 months, and 17 years and 2 months, with histologically verified Ewing sarcoma of the bone, referred to the Radiological Department of University Hospital No 6., John Paul II Upper Silesian Centre for Child Health Katowice, in the period from 1996 to 2007, were included in the study.Plain radiography was performed in every child, CT in 20 and MRI in 12 individuals. Tumour location, extension of the tumour, soft tissue mass, and periosteal reaction were taken into consideration in the evaluation of the lesion. In some cases, pathological features of the MRI and CT were compared. The prevalence of some radiological features was compared to the literature data. Results: The most common site of tumor was: ribs (6 children), femoral bone (6 children), pelvis (4 children) and tibia (3 children). In 2 children, a primary tumor was diagnosed in the spine (multifocal in 1 child). X-rays revealed: periosteal reaction in 17 children (63%), soft tissue involvement in 19 children (70%), permeative component in 16 children (59%), and sclerotic component in 5 children (19%). In 10 children (37%), periosteal reaction was not detected. The examination revealed: soft tissue calcifications in 7 cases (26%), a well-delineated focus of destruction within bones in 3 children (11%), cortical thickening in 4 children (15%), cortical destruction in 4 children (15%), saucerisation in 3 children (11%), bone expansion in 3 children (11%), pathological fracture in 2 children (7%), cystic component in 1 child (4%), and vertebra plana in 1 child (4%).Reaction of tumors after i.v. contrast administration, shown on CT, was visible in 16 children - it was useful for a better description of the tumor and extension of the mass within the soft tissue.All MRI examinations (12 children) showed a heterogenous mass with ill-defined borders and a violated cortex. Low signal intensity of the tumor in a T1-weighted image and high signal intensity in a T2-weighted image was shown as well. Heterogenous enhancement of signal intensity on T1-weighted images could be observed after i.v. contrast administration. MRI examinations showed: tumor in an adjacent soft tissue in 11 children, and involvement of the epiphyseal plate or of the joint cavity in 6 children. Conclusions: X-ray and MRI are essential in diagnostics. CT examination is more useful to estimate periosteal reactions and destruction of bone and marrow cavity, especially in flat bones. However, to recognise a malignancy, it is necessary to perform a histopathological examination. In doubtful cases, the examination has to be verified as well