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Lump in the Back
Nabamita Chaudhury1, Pallab Basu2, Jadab Kumar Jana3, Nabendu Choudhuri4.
1Department of Medicine, KPC Medical College, Kolkata, 2Department of Biochemistry, College of Medicine and Sagore Dutta Hospital, Kolkata, 3Department of Pediatrics, Malda Medical College, West Bengal, 4Department of Pediatrics, KPC Medical College, Kolkata.

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Chaudhury N, Basu P, Jana J K, Choudhuri N. Lump in the Back (Myelomeningocele with ulceration). Pediatr Oncall J. 2012;9: 51-52. doi: 10.7199/ped.oncall.2012.22

Address for Correspondence
Dr Pallab Basu, Akriti, 13, Dr Nilmoni Sarkar Street, Kolkata – 90

Email
dr.pallab_basu@rediffmail.com

A neonate presented with a lump in the lower back with ulceration over that.

What is the diagnosis?

 
Answer: Myelomeningocele with ulceration. Myelomeningocele and other associated malformations of the spinal cord arise from restricted failure of posterior neuropore which usually closes with in 26 weeks of gestation. Myelomeningocele is characterized by herniation of the meninges and spinal cord at the site of the lesion. These lesions are most common in lumber or lumbosacral region. It is very difficult to diagnosis in intra uterine life. Ultrasonography may help but better diagnostic tool is MRI. Alpha feto protein {AFP} is increased in amniotic fluid as well as maternal serum because of leakage of AFP from meningomyelocele. {1} It is not pathognomic as there are other conditions where AFP is raised like esophageal and duodenal atresia, annular pancreas, omphalocele, congenital nephrosis, polycystic kidneys, renal agenesis or fetal demise. Maternal AFP is raised in multiple pregnancies. {2} The optimal time of determination of maternal serum AFP is 16-18 weeks of gestation and in amniotic fluid at 14-16 weeks of gestation. Treatment consists of aggressive surgery for better care.

E-published: April 2012 Vol 9 Issue 4 Art # 22
 
Funding: None
 
Conflict of Interest: None

References :
  1. Cuckle HS. Screening for neural tube defects. In Bock G, Marsh J (eds). Neural Tube Defects. Ciba Foundation Symposium 181. Chicester John Wiley andSons, 1994: 253-267.
  2. Brock DJ. Mechanisms by which amniotic –fluid alpha-feto protein may be increased in fetal abnormalities. Lancet 1976; 2:345.  [CrossRef]

DOI No. :  https://doi.org/10.7199/ped.oncall.2012.22
 
Cite this article as :
Chaudhury N, Basu P, Jana J K, Choudhuri N. Lump in the Back (Myelomeningocele with ulceration). Pediatr Oncall J. 2012;9: 51-52. doi: 10.7199/ped.oncall.2012.22
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