CORRESPONDENCE

To the Editor:

I read with interest the article by Chin et al entitled “CongenitalCysts of the Third and Fourth Pharyngeal Pouches or Pyriform SinusCysts” in which the authors present 2 newborn cases with a literaturereview.1 They state that there is a subtle distinction between the thirdand fourth pharyngeal pouch cysts, which was not clarified in many ofthe previous reports and mention about the right-sided lesions in a fewarticles. However, insofar as congenital pharyngeal pouch cysts areconcerned, 2 separate cases of the fourth pharyngeal pouch remnants,a left-sided lesion in a 7-month-old boy and a right-sided lesion in an8-year-old boy, were reported discussing the subject with an extendedliterature review.2,3 We had also stressed on the rarity of the right-sidedpharyngeal pouch remnants, which could be more truly recognized bythe appropriate knowledge of anatomic and embryologic observations.3

Furthermore, for defining the exact origin, the relationship of the fistula

to the nerves of the fourth and fifth arches, the presence of thyroidtissue alone or with thymic tissue also within the wall, the parathy-roids, relationship to the thyroid, and the location of the internalorifice in the pyriform sinus above or below the superior laryngealnerve plica had been suggested.4 It has to be emphasized that thesecongenital pharyngeal pouch remnants do manifest themselves atany age onboth sides of the neck with a left-sided predilection anda thorough review of the literature must anddo include the afore-mentioned case reports.

Fatih Andiran, MDFatih University Medical FacultyDepartment of Pediatric SurgeryAnkara, Turkeydoi:10.1053/jpsu.2001.25807

REFERENCES

1. Chin CA, Radhakrishnan J, Slatton D, et al: Congenital cysts ofthe third and fourth pharyngeal pouches or pyriform sinus cysts.J Pediatr Surg 35:1252-1255, 2000

2. Tanyel FC, Cakmak O, Caglar M, et al: Fourth pharyngealpouch remnant presented as a neck mass. Z Kinderchirurgic 41:360-361, 1986

3. Andiran F, Tanyel FC, Hicsonmez A: A fourth pharyngeal pouchremnant located in the right side of the neck. J Pediatr Surg 33:1734-1735, 1998

4. Cahit Tanyel F, Arslan I: The endoscopic and surgical manage-ment of pyriform sinus fistulae in infants and children. J Pediatr Surg22:188, 1987

REPLY

To the Editor:

I agree that my oversight in not including the article by Andiran F,et al (reference 3) should be corrected. We did not refer to the articleby Cahit, Tanyel F, Arslan I (reference 4) because the issues theydiscussed had been discussed previously by other investigators whohave been given credit in our paper.

Jayant RadhakrishnanDes Plaines, ILdoi:10.1053/jpsu.2001.25808

To the Editor:

In the March 2000, issue of your journal, Digoy et al,1 reported acase of invasive rectal adenocarcinoma in a 17-year-old girl withtuberous sclerosis complex (TSC). They commented that they thoughtthis was the first such reported case. My colleagues and I2 had reportedon a 24-year-old man with Dukes D colon cancer in 1992. We hadreviewed the literature regarding gastrointestinal manifestations ofTSC. Since then, investigators have reported several other cases ofgastrointestinal lesions associated with TSC. Most reports documentedlesions already included in our 1992 article. Several previously unre-ported lesions have been documented. In 1999, Maluf and Dieckgraefe3

presented a patient with angiomyolipoma of the large intestine. Also in1999, Verhoef, et al4 presented a patient with a malignant pancreatic

tumor. In 1996, Maesawa et al5 also had reported a case of angiomyo-lipoma of the colon. Finally, in 1991, Byard et al6 described a patientwho had 2 different unreported tumors: one was a basal adenoma in thesalavary gland; subsequently, a year later, a leiomyoma of the colondeveloped in the patient. Interestingly, over time, more and morelesions of the gastrointestinal system have been documented in patientswith TSC. The question still remains as to whether they are directlyassociated with the gene abnormality causing TSC or whether they aremerely interesting coincidental processes.

Harry Moulis, MDDaytona Beach, FLdoi:10.1053/jpsu.2001.25809

REFERENCES

1. Digoy GP, Tibayan F, Young H, et al: Adenocarcinoma of therectum with associated colorectal adenomatous polyps in tuberoussclerosis: A case report. J Pediatr Sur 35:526-527, 2000

2. Moulis H, Garsten JJ, Marano AR, et al: Tuberous sclerosiscomplex: Review of the gastrointestinal manifestations and report of anunusual case. Am J Gastroentero 87:914-918, 1992

1317Journal of Pediatric Surgery, Vol 36, No 8 (August), 2001: pp 1317-1319