We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Pathological Case of the Month FREE

Timothy A. Sentongo, MD; Richard I. Markowitz, MD; Pierre Russo, MD; Daniel vonAllmen, MD; David A. Piccoli, MD
[+] Author Affiliations

Section Editor: Enid Gilbert-barness, MD

More Author Information
Arch Pediatr Adolesc Med. 2002;156(4):405. doi:10.1001/archpedi.156.4.405.
Text Size: A A A
Published online

A 26-MONTH-OLD GIRL was evaluated for stunted growth (weight, height, and head circumference less than the 5th percentile for age) and a 2-month history of altered bowel patterns with perianal pain. The decelerating growth pattern was first noted between the ages of 6 and 12 months, when her weight and length for age-growth percentiles fell from the 25th and 50th, to 5th and 25th, respectively. They later fell to less than the 5th percentile at the time of consultation. The 3-day diet record obtained at consultation revealed an average caloric intake of 121 kcal/kg per day (protein, 12%; carbohydrate, 57%; fat, 31%). Loose stools alternating with constipation characterized the altered bowel pattern. There was no history of mucus in stools, melena, or hematochezia. The perianal pain was most prominent when she sat in her car seat and immediately prior to bowel movements. She was born after a full-term pregnancy and had normal gross motor milestones, fine motor skills, and language development. Apart from small stature and minimal subcutaneous fat tissue, the rest of her physical examination results were within normal ranges. There was no anal fissure or other external perianal lesion. Laboratory tests included a normal hemogram, hepatic panel, sweat chloride, serum vitamin E level, and antigliadin/antiendomysial antibodies negative for celiac disease. Upper gastrointestinal endoscopy showed normal small-bowel mucosa and histology. The digital rectal examination performed prior to flexible sigmoidoscopy (normal) revealed a firm presacral mass that was further delineated by axial computed tomography (Figure 1). The serum α-fetoprotein level subsequently obtained was 1980 ng/mL (normal range, 0.6-11.1 ng). Histologic sections from the tumor mass resected at laparotomy are seen in Figure 2.


Accepted for publication July 3, 2000.

Corresponding author: Timothy A. Sentongo, Division of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Medical Center, 2300 Children's Plaza, No. 65, Chicago, IL 60614-3392 (e-mail: TSentongo@childrensmemorial.org).




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Detecting the Likelihood of Pregnancy

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Is This Patient Pregnant?