Objective Description of the clinical presentation and tumor behavior, its general and pathological characteristics, diagnostic and therapeutic approaches, as well as treatment outcomes in children with neuroblastoma (NB) at a single-center. Special focus was placed on the duration of the diagnostic process and the correlation between disease stage, presence of metastases, and treatment outcomes. Given the small cohort, this report is presented as a descriptive case series complemented by a focused review of the literature NB. Material and Methods A retrospective study was conducted for the time period from January 1st, 2010, to December 31st, 2024. The study included 13 patients (7 males, 6 females; median age: 44 months; range, 0-114) diagnosed with NB who underwent surgery and were hospitalized at the Department of Pediatric Surgery, Clinical Center of the University of Sarajevo. Demographic, clinical, biochemical, radiological, and treatment data were extracted from medical records. A narrative review of major published NB cohorts was conducted to compare our observations with existing evidence. Results The median age at diagnosis was 44 months. The largest number of patients were in the age group of 2-4 years, and most presented with stage four disease (according to International Neuroblastoma Staging System classification). The tumor was located in the adrenal gland in 92.3% of cases. The median survival time was 36 months. Patients had elevated serum neuron-specific enolase, urinary vanillylmandelic acid, as well as blood ferritin and lactate dehydrogenase levels. The most common symptoms were loss of appetite, presence of a palpable mass, and abdominal pain. Metastases were present in 76.9% of patients, and stage four was associated with aggressive metastatic dissemination. A multimodal approach was used in treatment. The median time from symptom onset to primary care physician consultation was 12 days, and the median time from physician consultation to diagnosis was 14 days. Relapse occurred in 46.2% of cases, most frequently in patients with stage four disease. A total of 7 patients (46.2%) survived. Conclusion Advanced-stage disease at diagnosis, metastatic burden, and unfavorable outcomes, are dominating factors in our single-center experience. When compared with larger published cohorts, our findings align with global patterns. Due to inherent sample size limitations, these observations are hypothesis-generating and the need for larger, multicenter studies remains.

Background This study explored whether tumor regression following neoadjuvant therapy can be used as a reliable indicator of surgical operability in patients with stage IIIA non-small cell lung cancer (NSCLC). Methods A retrospective cohort analysis was performed, including patients with stage IIIA NSCLC treated at a tertiary thoracic surgery center. Patients were categorized according to treatment approach: induction therapy followed by surgery or primary surgical management. Treatment response was assessed using imaging findings, pathological staging changes, residual tumor burden, and lymph node status. Surgical feasibility and perioperative outcomes were evaluated. Statistical significance was defined at p<0.05. Results Patients receiving induction therapy demonstrated greater tumor reduction, higher rates of mediastinal nodal regression, and more frequent complete pathological response. Complete (R0) resection was achieved more often in this group. Tumor regression and nodal response were identified as independent predictors of surgical feasibility. Postoperative complication rates and mortality did not differ significantly between groups. Conclusion Tumor response after neoadjuvant therapy is closely associated with surgical operability in stage IIIA NSCLC. Response-based selection may improve resectability without increasing perioperative risk.

Abstract Congenital intrinsic obstruction at or near the duodenojejunal junction is exceptionally rare and most commonly results from incomplete embryonic recanalization, leading to the formation of a mucosal web. We report a 7-day-old term male neonate (birth weight 3350 g) who presented with persistent feeding intolerance and intermittent bilious vomiting since birth. Abdominal radiography showed marked dilation of the stomach and duodenum with distal bowel gas. An upper gastrointestinal contrast study revealed a conical narrowing at the duodenojejunal junction. Surgical exploration revealed a mucosal web located immediately distal to the duodenojejunal junction. Given the marked luminal disparity, simple web excision was deemed inadequate, and segmental resection with primary end-to-end jejunojejunal anastomosis was performed. Postoperative recovery was uneventful. Proximal jejunal webs near the duodenojejunal junction are rare but surgically correctable causes of neonatal bilious vomiting and should be considered in the differential diagnosis.

AIM Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal neoplasm of intermediate biological potential, characterized by spindle cell proliferation and significant inflammatory component. This study aimed to determine the clinicopathologic characteristics, the clinical outcomes of inflammatory myofibroblastic tumor cases in the low-volume pediatric surgery service in a developing country. MATERIALS AND METHODS The study included data from all IMTcases diagnosed and operated from 2010 to 2024  at the Clinic of Pediatric Surgery, Clinical Center University of Sarajevo. RESULTS Three pediatric patients (two females, one male) diagnosed with IMT were analyzed for demographic, clinical, histopathological, immunohistochemical, and outcome parameters. All tumors were located in the abdominal or abdominopelvic region, with a median patient age of 4 years. Clinical manifestations included non-specific gastrointestinal symptoms (n=2) and systemic signs such as fever (n=2), weight loss and weakness (n=1). Complete surgical resection was conducted in all patients, and all experienced complete remission without recurrence. Histopathological analysis revealed consistent presence of spindle cells within a prominent inflammatory milieu, rich in plasma cells and lymphocytes. Immunohistochemically, all tumors were positive for vimentin, ALK, and SMA, while ALK-FISH analysis (performed in one case) was negative. No significant nuclear atypia or mitotic activity was observed. CONCLUSION Our study showed the constant of its heterogeneous morphology, and significance of IMTs immunophenotype, particularly in older children, where the inflammatory component is more pronounced. ALK gene alterations are commonly associated with IMT, as well as with other types of pediatric neoplasms, however, favorable outcomes in our cohort study, raise question regarding further need to clarify the prognostic significance of molecular findings and their potential therapeutic implications.

We report an infrequent case of a full-term male neonate presenting with a large congenital hernia of the umbilical cord (6 cm × 6 cm) containing only the entire left lobe of the liver. Prenatal ultrasonography suggested an omphalocele; however, the definitive postnatal diagnosis was established based on the presence of a narrow rim of normal skin encircling the umbilical ring and the proximal umbilical cord. Primary closure of the fascial defect was achieved successfully, with no intraoperative or postoperative complications observed. The patient recovered well postoperatively and was discharged in stable condition. Accurate differentiation from an omphalocele is crucial for appropriate management. Unlike omphaloceles, congenital hernias of the umbilical cord (CHUC) typically do not require extensive genetic or cardiac evaluation, and their surgical repair is generally less complex. However, awareness of atypical presentations of CHUC can aid in timely diagnosis, guide surgical planning, and improve clinical outcomes.

Background: Testicular torsion scoring systems, based on a combination of clinical and imaging factors, have been developed to improve the diagnostic accuracy of testicular torsion in patients presenting with acute scrotum. This study aimed to validate and compare two current testicular torsion scores the Boettcher Alert Score (BAL) and the Testicular Workup for Ischemia and Suspected Torsion (TWIST)-in a retrospective cohort of pediatric patients with acute scrotum. Methods: We conducted a retrospective study of all pediatric patients admitted to our institution for acute scrotum between January 2010 and December 2022. Patients were categorized into the testicular torsion (TT) group and the non-testicular torsion (NTT) group. Collected data were used to calculate the scoring systems and perform statistical analyses. Results: A total of 241 patients were included, of whom 80 (33.2%) had testicular torsion. The mean age in the TT group was 13 years. The optimal individual cut-off value for the BAL score was >1 (sensitivity 90%, specificity 80.75%), and for the TWIST score >4 (sensitivity 82.5%, specificity 80.75%). A high-risk TWIST score >5 had a specificity of 80.75% and a negative predictive value (NPV) of 90.28%, while a BAL score of 4 showed a specificity of 98.48% and NPV of 94.2%. The area under the ROC curve was slightly higher for the BAL score (0.917; 95% CI, 0.875–0.949) than for the TWIST score (0.897; 95% CI, 0.851–0.932). The difference between the two scores was not statistically significant. Conclusion: The TWIST and BAL clinical scores have significant diagnostic value and may assist in the evaluation of testicular torsion in children. Both scores could be incorporated into a standardized approach for assessing pediatric acute scrotum, potentially reducing time to definitive diagnosis, and minimizing ischemia duration.

Symptomatic Meckel’s diverticulum (MD) has various clinical presentations and can be easily misdiagnosed. This multicenter study examines the clinical characteristics, management, and outcomes of patients across five academic pediatric surgery centers in Bosnia & Herzegovina and Serbia. We retrospectively included all pediatric patients (< 18 years) who were surgically and histopathologically confirmed to have symptomatic MD between 2011 and 2020. Demographics, clinical and radiological features, surgical treatment approaches, histopathologic findings, and outcomes were collected and analyzed. Among 151 patients (80.1% male), the median age was 6.7 years (IQR 1.5–10.8). Presentations included intestinal obstruction (38.4%), GI bleeding (37.8%), and peritonitis (23.8%); 63.6% had multiple symptoms. A technetium-99 m scan was positive in 80.7% of bleeding cases. Laparotomy was performed in 72.2%, laparoscopy in 23.2%, and conversion in 4.6%. Partial small bowel resection was required in 80.8%, versus diverticulectomy in 19.2% (p < 0.001). Ectopic mucosa was found in 55.6% (gastric 48.3%, pancreatic 2.6%, both 4.6%; p = 0.05), significantly more common in males (p < 0.001). Postoperative complications occurred in 3.2%, with no mortality. Symptomatic MD displays highly variable clinical presentations. It is often underdiagnosed preoperatively, particularly without GI bleeding, emphasizing the need for high clinical suspicion and tailored surgical approaches.

Objective This study aimed to evaluate the functional status of the urethra using uroflowmetry before surgery, as well as three and six months postoperatively in cases of distal hypospadias. Material and Methods Thirty-nine consecutive patients who underwent surgery for distal hypospadias (hypospadias group) between 2016 and 2019 were prospectively included as part of this study. The control group consisted of 40 patients with a normal urethra who underwent surgery due to conditions other than hypospadias (phimosis, undescended testis, hernia). Uroflowmetry was performed preoperatively in these patients. Postoperative uroflowmetry was performed at three and six months following hypospadias surgery. Uroflowmetric results [maximum flow rate (Qmax), average flow rate (Qave), voided volume, void duration, flow start time, time to maximum urine flow rate, post-void residual urine, flow curve] were compared between the groups. Results The mean age for the patients with distal hypospadias was 35.9±29.6 months and 40.8±26.1 months for the control group. Pre- and postoperative Qmax values (three and six months after surgery) were 6.9 mL/s (0.1-15), 6.4 (0.2-14), and 7.5 (2.5-15). Qave values were preoperatively 4.0 (0.1-12.1), 3.8 (0.3-8.1), and 4.7 (1.0-11.1) mL/s three and six months after surgery, respectively. Bell-type flow was the most frequent uroflow flow curve in the preoperative hypospadias and control groups (95% and 66.6%, respectively). Postoperatively, bell-type flow remained the most common pattern, while a significant reduction in plateau-type flow was observed. Four boys (10.3%) had symptoms of obstruction. Conclusion Surgery improved urination dynamics and partial urethral obstruction of hypospadias cases that were present from the baseline. The urinary flow rates improve over time as the reconstructed neourethra regains functionality six months after the tubularized incised plate procedure.