Israel Medical Association Journal

Background: Pediatric functional visual loss (FVL) is the loss of vision in a child that cannot be explained by an organic pathology. In the last decade, only a few studies on pediatric FVL have reported long-term patient follow-up.

Objectives: To report the characteristics of pediatric FVL with long-term follow-up in Israeli children.

Methods: We conducted a retrospective chart review of the medical records of patients with FVL from 2000 to 2010. Only children with adequate follow-up (at least 2 months) were included.

Results: Of the 12 patients identified, 9 were females. Mean patient age was 10.5 ± 4.4 years (range 3.5–17 years). Most children (75%) had bilateral visual loss. One patient had a history of psychiatric illness and in three patients a preceding psychosocial event/trauma was identified. Brain imaging and electrophysiology testing (if done) were normal in all cases. No medications were prescribed to any of the patients, and all were reassured that there was a high chance of spontaneous resolution. The follow-up time was 2–108 months (mean 23.8 months, median 6). During the follow-up period 9 of the 12 had complete resolution and 2 had relief of symptoms. Three patients reported a recurrence of symptoms. No organic disease was ever diagnosed in this group.

Conclusions: FVL may occur in all age groups, including children. In cases of visual loss, it is usually bilateral and can involve both acuity and visual field loss. In the present report most of the patients experienced normalization or relief of their symptoms without medical treatment.
 

Background: Fibroadema, one of the most common benign breast lesions, has a characteristic age-specific incidence and is associated with other pathological entities in 50% of cases. The clinical or imaging diagnosis of fibroadenoma may be erroneous, and in some cases is found to be invasive cancer. The clustering of such entities, their correlation with age, and the risk of synchronous breast malignancy are uncertain.

Objective: To explore the possibility of any sigficant clustering of fibroadenoma-associated benign breast disease and to assess the possible risk of concomitant breast cancer.

Method: We analyzed the pathological results of 147 women undergoing excisional biopsies for fibroadenoma diagnosed pre-operatively either by clinical examination and imaging (n=117) or by radiology alone (n=30). The inter-relationships among all entities associated with fibroadenoma were studies by hierarchial cluster analysis. The correlation of the various pathologies with the risk of invasive breast cancer in relation to the patient’s age was also evaluated.

Results: Fibroadema-associated pathologies were found in 48% of the cases: sclerosing adenosis (23%), duct ectasia (17/7%), apocrine metaplasia (15.6%), florid fibrocystic disease (12.9%), duct papillomatosis (11.6%), infiltrating duct carcinoma (5.4%), duct carcinoma in situ (3.4%), and 1 case of lobular carcinoma in situ (0.6%). An orderly internal hierarchy and three significant clusters emerged: a) epithelial apocrine metaplasia, duct ectasia and sclerosing adenosis (similarity coefficients 16.0, 11.0 and 8.0 respectively); b) papillomatosis, florid fibrocystic disease and calcifications (similarity coefficients of 6.0, 4.0 and 2.0 respectively); and c) infiltrating duct carcinoma in situ (similarity coefficients of 1.8 and 1.6 respectively). Seven of the eight patients with breast cancer were older than 40 years.

Conclusions: In about half of the cases fibroadema was associated with other pathological entities clustered in an orderly hierarchy. The rarity of synchronous breast cancer in the younger age group and its more common association with fibroadema in the older age groups dictate a different approach to each. The finding of fibroadema in women older than 40 indicates the need for surgical excision.