Background Thyroid teratoma is an exceptionally rare germ cell tumor in the pediatric population, accounting for less than 1% of childhood teratomas. Despite its rarity, it may cause life-threatening airway compression, particularly in neonates and infants. Case presentation We report the case of an 8-month-old infant who presented with a progressively enlarging, painless anterior neck mass measuring approximately 6 cm in its largest diameter, associated with dysphagia. The infant had been followed by a pediatric endocrinologist since the age of 2 months, when the TSH level was initially elevated but subsequently normalized spontaneously.Neck ultrasonography revealed a well-circumscribed, heterogeneous mass with both solid and cystic components, originating from the thyroid gland and displacing adjacent cervical structures without evidence of local invasion. Serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG) levels were within normal limits.The patient underwent complete surgical excision of the tumor through a cervical approach, including resection of the right thyroid lobe, which had been completely replaced by the mass.Histopathological examination confirmed the diagnosis of a mixed mature and immature thyroid teratoma. The surgical margins were free of tumor.The postoperative course was uneventful. At 42 months of follow-up, the child remained asymptomatic, with hypothyroidism managed with medication and no evidence of local recurrence. Conclusion Teratoma must be included in the differential diagnosis of cervical masses in infants.
Introduction Renal artery stenosis (RAS) in neurofibromatosis type 1 (NF-1) can cause hypertension and end-organ dysfunction, while coexisting sickle cell disease (SCD) significantly compounds perioperative risk, posing a unique therapeutic challenge in pediatric patients. Case presentation A 13-year-old male with HbSC disease, NF-1, and right RAS-associated hypertension presented with vaso-occlusive pain and hypertensive urgency. CTA demonstrated high-grade celiac and superior mesenteric artery origin stenoses, long-segment high-grade right RAS with ipsilateral renal atrophy (scintigraphy: 60%/40% left/right function), and mild infrarenal midaortic syndrome. Multidisciplinary consensus favored right renal autotransplantation to address renovascular hypertension and preserve function. Celiac and superior mesenteric artery stenoses were asymptomatic, and midaortic syndrome intervention was deferred given absent upper-to-lower extremity blood pressure gradient and intact distal pulses.Preoperative erythrocytapheresis reduced the combined HbS/HbC to below 30%. The patient underwent laparoscopic right nephrectomy, back-table renal vessel modification, autotransplantation to the ipsilateral iliac vessels via right flank incision, and ureteroneocystostomy without complication. Low-dose aspirin and mechanical thromboprophylaxis began on postoperative day (POD) 0, with prophylactic enoxaparin added on POD 5. Renal function remained stable, and imaging confirmed a well-perfused graft and patent anastomoses.Given the SCD-associated hypercoagulability and mildly low protein C activity (57%), the patient was discharged on POD 8 on aspirin and six weeks of prophylactic apixaban, remaining asymptomatic with significantly improved blood pressure control and continued graft perfusion. Conclusion Renal autotransplantation seems to be a safe and effective management option for children with neurofibromatosis type 1, hemoglobin SC disease and renovascular hypertension. Preoperative erythrocytapheresis and renal autotransplantation were associated with successful blood pressure control and preservation of renal function in this patient.
Introduction Ewing sarcoma is classically considered to be an osseous tumor. Soft tissue Ewing sarcoma is rare and less likely to have associated clinical symptoms. Case presentation Here we report the case of an 8 year old male patient presenting for 2 months of hematuria and associated left flank pain who was found to have a tumor of the left kidney initially identified by computed tomography (CT). Resection of the tumor was completed via left total nephrectomy; pathology from the MayoComplete Solid Tumor Panel revealed Ewing sarcoma. Following resection, the patient underwent 27 cycles of chemotherapy, with radiotherapy initiated on week 13 of treatment. Post-treatment positron emission tomography (PET) scans at 6 and 10 months post-treatment have shown resolution of the disease. Conclusion Surgical resection followed by chemotherapy plus radiotherapy seems to be an efficient treatment for non-metastatic renal Ewing sarcoma in children in the short term.
