Journal of pediatric and adolescent gynecology最新文献

Background: Non-gestational ovarian choriocarcinoma (NGOC) is extremely rare, particularly in the pediatric population. Few case reports have discussed NGOC with precocious puberty and mentioned both tumor markers (β-hCG, AFP, CA125) and the dynamics of gonadotropic and gonadal hormones.

Case: A 7-year-old girl presented with early puberty and an abdominal mass. Laboratory tests revealed elevated estradiol, β-hCG, and CA125 levels, with suppressed LH and FSH. She was diagnosed with ovarian choriocarcinoma and precocious puberty. Following tumor resection, her hormone levels normalized and symptoms resolved.

Conclusion: Pediatric ovarian choriocarcinomas are rare and may present with precocious puberty. Comprehensive endocrine evaluation, including serum hormone assays, is essential for diagnosis. Hormonal profiles in pediatric patients may differ from those in adults, with estradiol levels often being markedly elevated compared to age-specific reference ranges, and progesterone levels being relatively low.

Purpose: This study presents a 24-year single-center experience in treating pediatric paraovarian tumors. It examines their key characteristics and discusses diagnostic and management considerations.

Methods: We performed a retrospective analysis of medical records for pediatric patients who underwent surgery for an adnexal mass from January 2000 to April 2024. The inclusion criteria were based on intraoperative diagnoses of paraovarian cysts, which were later confirmed by final surgical pathology reports.

Results: Seventy-one patients operated on for paraovarian cysts were identified. Their ages ranged from 10 to 18 years, with a median age of 15 years. The primary complaint was abdominal pain, reported by 47 patients (66%). This pain was attributed to adnexal torsion in 29 cases (41%) and the presence of a mass in 19 cases (27%). Mass effects were observed in six patients (8%). Preoperative diagnoses were correct in 52% of the cases, while intraoperative accuracy reached 99%. None of the patients showed signs of malignant transformations. The preferred surgical approach was laparoscopy, which was performed on 59 patients (83%). Adnexal-sparing surgery was conducted in 70 patients, while one patient required adnexectomy following spontaneous subtotal amputation due to torsion.

Conclusion: Accurately identifying paraovarian cysts during surgery is essential for effective management and adnexal preservation. Due to the risk of torsion, surgical intervention should be considered even for small and asymptomatic paraovarian cysts. In cases where there is uncertainty, laparoscopy is a valuable tool for both diagnosis and treatment. Laparoscopic excision is a feasible, less invasive, and safe approach to treatment.

Background: Juvenile granulosa cell tumors (JGCT) are the most common pediatric ovarian sex cord-stromal tumor. Because most granulosa cell tumors are hormonally active, patients commonly present with signs and symptoms of endocrine dysfunction, including precocious puberty and menstrual irregularities. Most patients with JGCT present with stage I disease confined to the ovary and can be managed with surgical excision alone with a favorable prognosis.

Case: A 15-year-old girl presented with primary amenorrhea. Evaluation revealed suppressed FSH, elevated LH, normal estradiol and a markedly elevated inhibin B, and pelvic US and MRI showed a mildly enlarged right ovary with a 1.6-cm "ovarian follicle". Following consultation with gynecologic oncology, the patient underwent right salpingo-oophorectomy with histopathologic findings consistent with JGCT. Menarche subsequently occurred two months following surgery.

Study objective: TikTok is a social media platform where patients can access and share information about intrauterine devices (IUDs). The primary objective of this study was to identify prominent themes of creators' experiences with IUDs on TikTok.

Methods: We conducted a quantitative and qualitative assessment of eligible videos that appeared when searching for "IUD" on the TikTok platform between July 2019- August 2022. Eligible videos contained content relevant to IUDs and were spoken and/or written in English.

Results: Of the 354 videos that met inclusion criteria, the majority were created by users without healthcare expertise (77%) and mentioned personal experiences with IUDs (68%). However, videos that were educational (27%) or created by users with healthcare expertise (23%) averaged more likes and views than other video types. Common content areas included IUD insertion (45%), side effects (31%), and removal (25%). Perceived gaps in knowledge about the insertion procedure and feeling that providers did not adequately prepare patients for the procedure contributed to dissatisfaction with IUD insertion and motivated creators to share their experiences on TikTok. Video creators often relied on information that they found on TikTok to educate themselves about the IUD insertion process and expressed frustration at unacceptable levels of pain during insertion.

Conclusion: Healthcare providers should be aware that adolescent patients who use TikTok have likely seen videos depicting negative experiences with IUDs and be prepared to address patients' concerns, particularly regarding IUD insertion. Additionally, healthcare providers may use TikTok to educate users about IUDs.

Study objective: To evaluate current practices and examine patient and provider characteristics associated with delivery of fertility-based counseling and pursuit of oocyte cryopreservation or autologous in vitro fertilization among individuals with Turner syndrome (TS) at a large academic institution.

Methods: A retrospective study was conducted between January 2010 and December 2020, involving phenotypically female individuals aged 0-26 years with TS.

Results: Of 108 included individuals with TS, 65 (60.19%) were classified as monosomy X, and 43 (39.81%) were classified as having TS with another karyotype. Individuals with monosomy X were more likely to have cardiac anomalies, hypertension, and low bone density compared to individuals with TS with other karyotypes. Rates of other comorbidities were similar between groups. Thirty patients (27.78%) received fertility and/or fertility preservation (FP) counseling, of which 6 (5.56%) pursued autologous assisted reproduction technology (ART). A multidisciplinary group of providers offered counseling. Individuals with other TS karyotypes were more likely to receive counseling compared to individuals with monosomy X (43.59% vs. 22.03%, p=0.027). Counseling was significantly associated with pursuing ART (20.00% vs. 0%, p<0.001). Other factors, such as race, ethnicity, and cardiac anomalies, were not associated with the receipt of counseling.

Conclusions: Approximately one-third of individuals with TS receive fertility and/or FP counseling, and only few pursued controlled ovarian hyperstimulation (COH). Our large cohort study underscores the need for standardized, system-wide measures to deliver fertility counseling to individuals with TS, including the development of a dedicated multidisciplinary program. Further investigations are necessary to evaluate the effectiveness of proficiency in delivering FP counseling to individuals with TS.

Background: Non-puerperal uterine inversion (NPUI) is particularly rare and presents a significant diagnostic challenge. This case report describes the youngest case of incomplete NPUI, noteworthy due to the unidentified factor that triggered the uterine inversion.

Case: This case report presents a retrospective analysis of a 19-year-old female patient diagnosed with incomplete uterine inversion, the main symptoms of which were vaginal bleeding, abdominal pain. Following hemostasis and broad spectrum antibiotics, the diagnosis of NPUI was confirmed through physical examination and supplementary examinations (ultrasonography and magnetic resonance imaging (MRI)). Surgical intervention involved transvaginal manual reduction, balloon hysteropexy and bilateral round ligament shortening via single-port laparoscopy.

Summary and conclusion: The multidisciplinary treatment approach employed in this case offers a novel therapeutic perspective for the treatment and management of NPUI. This report emphasizes the importance of accurate diagnosis and customized treatment strategies for NPUI.