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Study Objective In a pediatric setting, laparoscopic management of large cystic ovarian neoplasms with low malignancy probability is not suitable, because of the mass size; nevertheless, an effort should be made to be as minimally invasive as possible, without violating the principles of oncologic surgery. We describe our experience in managing these neoplasms with leak-proof extracorporeal drainage through mini laparotomy, followed by cyst excision or oophorectomy. Design Case series study, describing interventions and outcomes. Setting Department of pediatric surgery in a tertiary pediatric and adult university hospital. Participants Pediatric patients affected by large cystic ovarian mass. Interventions Hybrid minimally invasive approach using leak-proof extracorporeal drainage. Main Outcome Measures Data on demographic characteristics, tumor marker values, and imaging findings were collected and analyzed. Outcome of surgical technique was evaluated and reported. Results Between 2011 and 2018, 17 patients (mean age, 10.2 years; range, 2-14 years) affected by large cystic ovarian mass, were eligible for this technique. All patients had negative preoperative tumor markers. Of the seventeen subjects, 13/17 girls (76%) underwent pelvic magnetic resonance imaging. No sign of lymphadenopathy or metastasis was found. Surgery was successful in all patients, with ovarian preservation in 5/17 cases (29.4%). Mean surgical time was 98 minutes; no intra-abdominal leakage of neoplasm content or postoperative complications occurred. Mature cystic teratoma was the most frequent histopathological diagnosis (71%). Conclusion After a thorough patient selection, the management of large cystic ovarian neoplasms with leak-proof extracorporeal drainage performed through a mini laparotomy is a feasible and safe approach, with excellent cosmetic results. When achievable, ovarian-sparing surgery has to be considered.

The purpose of the paper was to assess the morphometric parameters to improve the specificity of the ultrasound (US) signs for the early differential diagnosis between two lethal dysplasias, as thanatophoric dysplasia (TD) and osteogenesis imperfecta type 2 (OI-2). The diaphyseal length and the bowed shape of long bones associated with vertebral body dimension assessment were investigated in a group of 14 pregnancy terminations carried out in the time period 2007–2013. The definitive diagnosis was established after pregnancy termination by means of skeletal standardized X-rays, histopathology and gene analysis. TD and OI-2 long bones were significantly shorter than controls. No significant differences were observed between the two dysplasias. The bowing angle was higher in OI-2; a true angulation or eventually axial displacement was present only in the latter. Furthermore, they did not show any evidence of vertebral collapse. The thanatophoric dysplasia presented less bowed long bones, and never true angulation. The spine was steadily characterized by flattened anterior vertebral bodies. Long bone shortening is not a sufficient and accurate sign for early sonographic differential diagnosis between TD and OI-2. Angled diaphysis, axial diaphyseal displacement and a conserved vertebral body height in the prenatal period support the diagnosis of osteogenesis imperfecta type 2, while moderately regular bowed diaphysis associated with platyspondyly that of thanatophoric dysplasia.

Imaging plays a pivotal role in the assessment of the lacrimal pathway. Several different techniques are available, some mainly offering information about patency and caliber of the lumina in the different tracts of the pathway, some others able to assess the morphology and structures of the bone envelop which surrounds the lacrimal pathway in large part of its course. In addition, cross-sectional techniques allow to assess the soft tissue structures which may be secondarily involved by disease of the lacrimal pathway or, on opposite, may be the site of origin of pathologies which secondarily involve it.

The SOCEUS survey aims to evaluate how contrast-enhanced ultrasound (CEUS) is effectively used in the focal liver lesions characterization.In the survey were involved Verona, Brescia and Trieste Radiological Centers and Arezzo and Bologna Non-radiological Centers. Inclusion criteria were liver focal lesion detection at conventional ultrasound and studied by means of CEUS, with or without CT or MRI examinations, done previous or subsequent to CEUS.1069 forms were collected. Patients with benign lesions, who did not undergo any other studies, were 255/561 (45.5 %). Among patients with diagnosis of hemangioma at CEUS, those who had no other investigations were 129/267 (48.3 %). Patients with malignant lesions who had studies pre-CEUS (CT and/or MRI) were 328/508 (65 %), whereas those who had examinations post-CEUS (CT and/or MRI) were 218/508 (42.9 %). Concordance rate between CEUS and CT investigations pre- and post-CEUS was, respectively, 66 and 89 %. Concordance rate between CEUS and MRI studies pre- and post-CEUS was, respectively, 87.5 and 81.5 %.This study proves contrast-enhanced ultrasound correct application in the involved centers.Il sondaggio SOCEUS ha lo scopo di valutare come l’ecografia con mezzo di contrasto sia effettivamente impiegata nella caratterizzazione delle lesioni focali epatiche.Nel sondaggio sono tati coinvolti i centri radiologici di Verona, Brescia e Trieste e i centri non radiologici di Arezzo e Bologna. I criteri di inclusione sono stati la presenza di lesione focale epatica all’esame ecografico convenzionale studiata con ecografia con mezzo di contrasto, con o senza correlazione TC or RM, prima o dopo l’esame ecografico.Sono state raccolte 1069 schede. I pazienti con lesioni benigne che non hanno fatto altri esami sono stati 255/561 (45.5 %). Dei pazienti con diagnosi di angioma alla ecografia con mezzo di contrasto, quelli che non hanno eseguito altre indagini sono stati 129/267 (48.3 %). I pazienti con lesioni maligne sottoposti ad indagini pre-ecografia con mezzo di contrasto (TC e/o RM) sono stati 328/508 (65 %), mentre quelli che hanno eseguito esami post- ecografia con mezzo di contrasto (TC e/o RM) sono stati 218/508 (42.9 %). La concordanza tra ecografia con mezzo di contrasto ed esame TC pre- e post-ecografia con mezzo di contrasto sono rispettivamente state pari al 66 e 89 %. La concordanza tra l’ecografia con mezzo di contrasto e l’esame RM pre- e post-ecografia con mezzo di contrasto sono state rispettivamente di 87.5 e 81.5 %.Lo studio prova che l’ecografia con mezzo di contrasto è utilizzata correttamente nei Centri valutati.

The purpose of this study is to evaluate the possibility of early detection of pulmonary fungal infections by lung CT scan in chronic granulomatous disease (CGD). A retrospective study on 14 patients affected with CGD for a total of 18 infectious episodes was performed. Revision of clinical data and CT scan analysis before and after treatment was performed. The presence of lung nodules

Cystosarcoma of the seminal vesicle is a very rare malignant tumor; in the literature only four cases are reported. We present a case of cystosarcoma phyllodes arising in the right seminal vesicle of a 49-year-old man without any urinary symptom but with persistent constipation. Ultrasound examination showed a mass at the right superior base of the prostate subsequently studied with CT and MRI. The patient underwent vesiculectomy; his postoperative course was uneventful. The patient is still well, without evidence of recurrent disease.