The Jarcho-Levin syndrome is a condition manifested by vertebral body and related rib malformations. We report on four new cases and review 57 cases from the literature. Analysis of the 61 cases suggests that there are two major subtypes (spondylocostal dysostosis and spondylothoracic dysostosis) with different survival rates, associated malformations, and inheritance patterns. Individuals with spondylothoracic dysostosis have vertebral body malformations and ribs which flare in a fanlike pattern but which are not significantly malformed. This is an autosomal recessive trait, and the patients have a higher mortality rate and greater incidence of neural tube defects. Individuals with spondylocostal dysostosis have vertebral malformations, frequent dramatic rib malformations, and short stature, but do not have a fanlike thoracic configuration. Most cases of spondylocostal dysostosis are inherited in an autosomal recessive fashion, although in a few families it is a dominant trait which is correlated with better survival. Respiratory compromise previously accounted for the high mortality in these conditions, but improvements in respiratory technology have increased survival. Appropriate classification of these similar phenotypes will improve counseling concerning recurrence risk, management, and prognosis.
Three cases of abdominal inflammatory pseudotumor or inflammatory myofibroblastic tumor of the small intestinal mesentery are presented with additional examples from the literature. An abdominal mass was detected in three preadolescent children who presented with fever, growth failure, hypochromic anemia, thrombocytosis and polyclonal hypergammaglobulinemia. The radiographic findings confirmed the presence of a mass. Following surgical resection, the systemic manifestations dramatically resolved. The solid mesenteric mass was composed of spindle cells with the features of myofibroblasts and mature plasma cells and small lymphocytes. Clinical follow-up confirmed the benign nature of this lesion with no signs of recurrence in any patient from 3 to 6 years after the initial surgery.
Computed tomography (CT) was used to evaluate mass effect on the greater curvature of the stomach in two children with histories of intermittent, recurrent vomiting. The paraduodenal herniae were identified on CT in both of these patients as small bowel interposed between the stomach and the body of the pancreas.
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