Background: Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease with rising incidence. While proton pump inhibitors (PPIs) are the first-line treatment, a significant proportion of patients do not respond. This study aimed to determine if the EoE Histology Scoring System (EoEHSS) can predict PPI responsiveness. Methods: A cross-sectional study was conducted on 89 pediatric patients diagnosed with EoE between 2016 and 2022. Patients were categorized into PPI responders (PPIREoE) and non-responders (PPINREoE) based on post-treatment biopsies. EoEHSS values from biopsies of the esophagus (distal, middle, and proximal segments) were compared between the two groups. Results: No significant differences in EoEHSS scores were observed for the distal and proximal esophagus between the groups. However, the middle esophagus showed a significantly higher EoEHSS grade score in the PPINREoE group, indicating a more pronounced disease severity. Specific histological features, particularly eosinophilic abscesses and surface layering of the middle segment of the esophagus, were significantly different between the groups. Conclusions: Performing a biopsy of each esophageal segment, particularly the middle, is crucial for diagnostic precision and predicting PPI responsiveness. The EoEHSS can serve as a valuable tool in predicting therapy response, emphasizing the need for personalized therapeutic approaches in EoE management.

Immune thrombocytopenic purpura (ITP) is an acquired immune-mediated bleeding disorder characterized by isolated low platelet (PLT) counts. Immune thrombocytopenic purpura pathogenesis involves multiple immune mechanisms causing PLT destruction and inadequate production. Owing to impaired immune homeostasis, ITP patients can develop other than anti-PLT autoantibodies even in the absence of clinical signs of autoimmune disease, such as anti-thyroglobulin (TG) and anti-thyroperoxidase (TPO) antibodies. Our objective is to determine the prevalence of antithyroid antibodies (ATAs) in the population of pediatric ITP patients, and the differences in ATA positivity prevalence in newly diagnosed/persistent ITP, and chronic ITP patient subgroups, as well as to establish the impact of ATA positivity on the treatment outcomes. A cross-sectional observational study was conducted involving 75 pediatric patients diagnosed with ITP and 60 healthy controls, carried out over a period of 11 years. The prevalence of ATA was significantly higher in ITP patients compared with controls (28% vs 5%, P < .05). Initial PLT count was significantly lower in ATA-positive patients, but the treatment response did not differ between ATA-positive and ATA-negative patients. To conclude, our study confirmed that ITP patients have a higher prevalence of ATA compared with the healthy pediatric population; however, no association was found between ATA positivity and disease duration or treatment outcomes. Our findings suggest that ATA screening may not be prognostic for ITP in pediatric population, but further research with larger cohorts may be beneficial to elucidate the role of ATA in ITP pathogenesis and management.

Introduction: The detection of suprarenal masses (SRM) in neonates and infants has increased due to widespread prenatal and postnatal ultrasonography. While surgery was historically the standard treatment, a conservative approach is now advocated for small, asymptomatic masses. This study aimed to analyze the management and clinical outcomes of SRM at a single tertiary care center over the last two decades. Material and Methods: A retrospective analysis of 39 patients diagnosed with SRM between 2006 and 2023 was conducted. Clinical, radiological (US, CT, MRI), and laboratory data (urinary VMA/HVA, NSE) were evaluated. The follow-up protocol consisted of ultrasonography every 2 weeks during the first 3 months of life, followed by monthly or quarterly evaluations until complete resolution, with a median follow-up of 16.6 months (range: 1.9–89). Patients were managed via upfront surgery or a conservative protocol. Results: SRM larger than 5 cm was identified in 18% of patients (7/39), of whom 5 underwent surgery and confirmed neuroblastoma (NBL), and in the remaining 2 patients, spontaneous resolution of the mass occurred. For the 32 patients with masses smaller than 5 cm, a conservative approach was initially adopted. Eight of these patients (25%) eventually required surgery due to elevated urinary catecholamines, which proved to be a reliable indicator of NBL. Complete regression was observed in all other cases managed conservatively. Conclusion: Close observation of small SRM is safe in carefully selected patients and effectively reduces unnecessary surgical interventions. Urinary catecholamine metabolites remain a valuable tool for identifying high-risk patients requiring surgical treatment.

Introduction: Hepatoblastoma is the most prevalent pediatric malignant liver neoplasm, and despite substantial advances in multimodal treatment, outcome data from Southeast European pediatric centers remain limited. The aim of this study was to evaluate the clinical characteristics, treatment approaches, surgical management, and outcomes of children treated for hepatoblastoma at a tertiary pediatric institution over a 17-year period. Methods: This retrospective single-center cohort study included 24 pediatric patients treated between January 2008 and March 2025. Clinical variables included age, sex, tumor size, PRETEXT stage, metastatic disease, and vascular involvement. Treatment variables comprised chemotherapy protocol, surgical procedure, liver transplantation, and resection margin status, while outcome measures included relapse, overall survival, and normalization of serum α-fetoprotein levels. Results: With the exception of one child who died before treatment could be initiated, all patients underwent surgical treatment following liver biopsy and preoperative chemotherapy. Overall, six children (25.0%) died, whereas 18 were alive at the time of analysis, corresponding to an overall survival rate of 75.0% with a median follow-up of 9.0 years. All patients with PRETEXT 1 and PRETEXT 2 disease survived, whereas survival among patients with PRETEXT 3–4 disease was significantly lower (100.0% vs. 50.0%, p = 0.014). Postoperative relapse occurred in two of the 23 treated patients (8.7%), and serum α-fetoprotein levels normalized after treatment in all surviving patients. Discussion: In this retrospective single-center cohort, multimodal treatment of hepatoblastoma achieved an overall survival of 75.0%, with particularly favorable outcomes in patients with PRETEXT 1–2 disease and negative surgical margins. These findings provide valuable long-term real-world evidence on hepatoblastoma management at a tertiary pediatric referral center.