No abstract

Breast enlargement is considered a physiologic event in male and female neonates. However, it is rarely encountered in infancy and is deemed unusual in young children beyond the first year of life.1,2 Breast enlargement along with bloody nipple discharge, first reported in 1983 3 appears to be even more uncommon in children. We report a case of a 4-year-old boy with a 2-week history of left breast enlargement with serosanguinous nipple discharge and ipsilateral palpable axillary lymph nodes. Case ReportA 4-year-old boy was referred to the pediatric surgical service after the mother presented her child with a history of bloody nipple discharge of one week duration to the emergency room physician. The mother noted blood stains initially on the boy's underwear and later saw blood coming out of the left nipple. There was no history of breast enlargement, pain or fever. Trauma and drug ingestion were denied. Physical examination revealed a healthy child with normal findings except for an ovoid mass measuring 2.5 x 1.5 centimeters above the left nipple. It was mobile, not attached to underlying structures or skin, firm, and not tender or hot. There was no erythema. Slight pressure on the mass instigated bloody discharge from the nipple (Figure 1). The left axilla revealed two enlarged lymph nodes, one measuring 0.5 centimeter, the other 2.0 centimeters in diameter. The right breast and axilla were normal. The testes were of normal size, configuration and consistency. The complete blood count, prothrombin time and partial thromboplastin time were normal. The breast mass, including the small nipple, were excised. Both axillary lymph nodes were removed as well.The frozen section proved to be a benign lesion. The paraffin section demonstrated many dilated ducts containing granular eosinophilic material and red blood cells. In some, there were many macrophages containing foamy granular material within the lumen and pronounced periductal fibrosis with a moderate chronic inflammatory reaction in the adjacent wall (Figure 2). An occasional dilated duct proved that focal ulceration was present. A section from the left nipple showed a few dilated ducts with similar microscopic changes. A section from the axillary lymph nodes illustrated sinus histiocytosis.

No abstract

No abstract

Case records of 33 patients treated for thyroglossal duct lesions at the King Fahd Hospital of the University, AlKhobar between 1982G and 1992G were reviewed. There were 22 males and 11 females, their ages ranging between one and 35 years. Sixteen patients presented as cysts and 17 as sinuses. All cases were diagnosed clinically. However, ultrasound was needed to confirm the diagnosis in five cases. Twenty-nine patients had undergone Sistrunk's procedure, while four had simple excision of the cyst. Postoperative complications included four wound infections, hoarseness due to edema of the vocal cords in one and recurrence in another case. The latter case and all four cases with recurrence referred to us for further management have undergone "Sistrunk's operation". All of them were cured by a single surgical intervention performed by surgeons trained in this field and with experience of Sistrunk's operation. Thyroglossal sinuses and infected cysts are associated with a higher rate of wound infection and recurrence. Excision is, therefore, indicated soon after the condition is diagnosed to minimize above-mentioned complications and to prevent malignant change, however rare. Ann Saudi Med 1994;14(2):136-138. Thyroglossal Duct Remnants. 1994; 14(2): 136-138 Thyroglossal duct remnant is not an uncommon surgical condition. It presents as a midline cyst or as an acquired sinus at any level from the tongue to the thyroid isthmus. The majority are in the hyoid region, but some may be as low as the suprasternal notch.1,2 Despite the common knowledge about its embryology, lack of clinical experience often results in misdiagnosis and inappropriate surgical treatment 3,4 with a high rate of recurrence and, at times, disfigurement.1 Occasionally the adjoining thyroid tissue develops thyroiditis, hyperthyroidism or carcinomatous change. 5,6 The purpose of this paper is to analyze the case records of patients seen in the last decade at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia and to possibly draw conclusions with a view to improve the outcome of treatment. Material and MethodsCase records of 33 consecutive patients admitted for thyroglossal duct lesions at the King Fahd Hospital of the University, Al-Khobar between 1982G and 1992G were reviewed. Four of these patients had been initially treated in other hospitals and referred to us because of recurrence. All charts were reviewed regarding age, sex, presentation, diagnostic modalities, operative procedures, histological findings and outcome. ResultsThere were 22 males (66.6%) and 11 females (33.3%), their ages ranging between one and 35 years. Twentythree patients (69.7%) were under 14 years of age.The diagnosis was made clinically in all cases; ultrasonic confirmation was needed in five; three times in adults to exclude ectopic thyroid tissue and two times in children below the age of two years to confirm the clinical diagnosis. The abnormality was associated with congenital laryngomalacia in one, and with multicystic goiter in another patient. The le...