Journal of pediatric and adolescent gynecology最新文献

{"title":"18. Bilateral Borderline Ovarian Tumors in a 15-Year-Old: A Rare Pediatric Case","authors":"Jennifer Silk,&nbsp;Katelyn Day,&nbsp;Laura Stafman","doi":"10.1016/j.jpag.2025.01.051","DOIUrl":"10.1016/j.jpag.2025.01.051","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian malignancy in pediatrics, with germ cell tumors being most common, is reported in 3–8% of patients. Borderline tumors, a type of tumor with low malignant potential showing cytologic traits of malignancy but lacking clear invasive growth, occur at even lower rates with no consistent statistical data reported. Pediatric bilateral borderline ovarian tumors (BOTs) have not been well described in the literature beyond case reports.</div></div><div><h3>Case</h3><div>A 15-year-old female presented to her pediatrician for a routine annual exam which revealed abdominal distention on physical exam. This prompted an abdominal x-ray and CT abdomen/pelvis which identified a 23 × 17.5 × 10.3cm cystic mass stemming from the left ovary. She initially did not report any complaints, but upon reflection, she stated that she felt distended one month prior and reported a ten-pound weight gain, fatigue, urinary frequency, light-headedness, and discomfort when stooling over the last two months. She underwent menarche at age 12 and denied any significant past medical or surgical history. She was referred to pediatric surgery for further evaluation. Tumor markers were significant for a slightly elevated CA125 (87) and inhibin-A just above normal limits (106). AFP, bHCG, LDH, and inhibin B were within normal limits. Her pelvic ultrasound noted a normal uterus, no free fluid, and a large multicystic and solid mass arising from the pelvis to the level of the liver. Due to the size of the mass, her ovaries were difficult to specifically delineate. The patient subsequently underwent an exploratory laparotomy that unexpectedly revealed masses on both ovaries, with the right mass appearing benign in the operating room and the left ovarian mass with concerning solid components and increased vascularity. Pelvic washings were obtained followed by ovarian-sparing excision of bilateral ovarian masses. Pathologic specimens were reviewed at the primary institution and sent for secondary review at an institution that specializes in pediatric ovarian pathology. The patient's pelvic washings were negative. The final diagnoses of the left (208.2g 18.5 × 14.8 × 3.2cm) and right (365 g 9.6 × 9.0 × 7.2cm) ovarian masses were proliferative serous BOTs.</div></div><div><h3>Comments</h3><div>This is an example of an extremely rare clinical scenario of bilateral serous BOTs in a pediatric patient. The case demonstrates the importance of an extensive preoperative workup for an abdominopelvic mass including imaging and laboratory assessment, collaboration of teams in the operating room and postoperatively, removal of masses without spillage in the abdominal cavity, and the significance of fertility preservation with ovarian-sparing mass excisions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 238"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"39. Extended Use of the Etonogestrel Implant in AYA","authors":"Areej Hassan ,&nbsp;Morgan Ryan ,&nbsp;Sarah Golub ,&nbsp;MIchelle Escovedo ,&nbsp;Sofya Maslyanskaya ,&nbsp;Sarah Pitts ,&nbsp;Amy DiVasta ,&nbsp;Carly Milliren ,&nbsp;Gabriela Vargas","doi":"10.1016/j.jpag.2025.01.072","DOIUrl":"10.1016/j.jpag.2025.01.072","url":null,"abstract":"<div><h3>Background</h3><div>Although the etonogestrel implant is FDA approved for 3 years, recent data demonstrate efficacy up to 5 years. Evidence supporting extended use is limited in adolescents and young adults (AYA), especially those with higher BMI. We report on the AYA experience of extended implant use.</div></div><div><h3>Methods</h3><div>This secondary data analysis used prospectively collected QI data of all implant insertions with ≥1 follow-up visit from September 2012 to December 2023 across 4 U.S. adolescent medicine practices. Baseline demographic and clinical characteristics were assessed. We used Chi-Square and Fisher's Exact tests to compare clinical characteristics between participants with device removal before 3 y, 3-4 y, and &gt;4 y. Univariable logistic regression was utilized to assess for factors associated with extended use. Kaplan Meier curves estimated continuation rates and Cox proportional-hazards modeling examined the risk of implant discontinuation accounting for site using a robust sandwich estimator</div></div><div><h3>Results</h3><div>We included 1317 AYA (mean age 18.6 y (SD 2.5)) in our analysis. Patients primarily identified as Hispanic/Latinx (36.4%), Black/African American (21.3%), or White (21.1%). Based on age-appropriate classifications, most participants were normal weighted (44%) at time of insertion; 15.4% were overweight, 27.9% obese. Of the 807 implant removals, unsatisfactory bleeding (45.4%) and weight concerns (11.9%) were the most frequent reasons for removal. One-fifth (20%) of removals (n=200) occurred 3-4 y after insertion, and 8% (n=67) &gt;4 y. Factors reported at removal that were significantly associated with shorter use of implant (≤3 y vs &gt;3 y) included perceived unsatisfactory uterine bleeding (OR 3.94, 95% CI 2.77 - 5.59, p&lt;.05), weight concerns (OR 14.17, 95% CI 4.44 - 45.21 p&lt; .05), and mental health change (OR 3.94, 95% CI 1.78 – 8.73 p&lt;.05). There were no pregnancies noted with extended implant use. The 1-year continuation rate was 78%, dropping to 56%, 36%, 12% and 2% at years 2, 3, 4, and 5. Our survival analysis (Fig) demonstrated a significant difference between BMI categories and time to discontinuation. Obese patients had the lowest discontinuation rates for the study period compared to normal weighted patients (hazard ratio adjusted for site 0.945, 95% CI 0.921-0.970, P&lt;.0001)</div></div><div><h3>Conclusions</h3><div>Over a quarter of participants kept their implant &gt;3 years. AYA are more likely to undergo early device removal for concerns related to mental health change, unsatisfactory bleeding, and weight. AYA with obesity at time of insertion may keep their device longer. No pregnancies were observed. Clinicians should engage in shared decision making with patients regarding extended use of the implant.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"41. Ferritin Screening in Female High School Student-Athletes Identifies Many who have Iron Deficiency","authors":"Alexis James ,&nbsp;Steven Fein ,&nbsp;Dayne Alonso","doi":"10.1016/j.jpag.2025.01.074","DOIUrl":"10.1016/j.jpag.2025.01.074","url":null,"abstract":"<div><h3>Background</h3><div>Iron deficiency (ID) is highly prevalent among teenage females. It has been associated with impaired concentration and fatigue, and it may affect both academic and athletic performance. In this study, we sought to quantify the prevalence of ID in teenage female student-athletes, and to correlate ID with fatigue, athletic performance, and academic performance.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study of female student-athletes in a suburban high school. After IRB approval, students were approached for study enrollment during a sports team practice session. After obtaining parental consent, students had ferritin testing and assessments of fatigue, athletic performance, and academic performance. Iron deficiency was defined as ferritin &lt; 30 ng/mL.</div></div><div><h3>Results</h3><div>Low ferritin (&lt; 30 ng/mL) was found in 8/23 (35%) female student-athletes. Only two had prior awareness that they had iron deficiency. Fatigue, athletic performance, and academic performance will be reported in a 2025 NASPAG presentation.</div></div><div><h3>Conclusions</h3><div>In this cross-sectional study of female student-athletes, we found that iron deficiency is common. Our finding, 35% with low ferritin, is consistent with the prevalence of iron deficiency among teenage females in a large NHANES-based cross-sectional study by Weyand, et al. Most of the students found to have ID in our study had no prior knowledge that they had iron deficiency. This study highlights the importance of iron deficiency screening in female student-athletes. More student-athlete screening will be reported in a 2025 NASPAG presentation.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 249"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"12. Adolescent Hyperandrogenism: Consider The Sinister Cause. A Case Report Of A Juvenile Granulosa Cell Tumour.","authors":"Grace Madigan,&nbsp;Nikita Deegan","doi":"10.1016/j.jpag.2025.01.045","DOIUrl":"10.1016/j.jpag.2025.01.045","url":null,"abstract":"<div><h3>Background</h3><div>We present the case of a 14 year old girl, referred to the Paediatric and Adolescent Gynaecology service for the assessment and management of hyperandrogenism. Ultrasound Pelvis revealed a 13cm adnexal cyst. The patient underwent a right salpingo-oophorectomy. Histology confirmed a juvenile granulosa cell tumour. This case underscores the importance of consideration of a broad differential diagnosis in the assessment of hyperandrogenism, including malignancy.</div></div><div><h3>Case</h3><div>Our patient presented with a history of incongruent pubertal development; Tanner Stage 1 breast development, in the setting of significant hirsutism, affecting the face, chest, lower abdomen, and inner thigh. US and MRI Pelvis were carried out, and showed a large adnexal cyst, measuring 11.4 × 4 × 7.4cm. Chest x-ray and adrenal US were both carried out and were normal. Testosterone was moderately elevated at 2.7nmol/L (0.22-1.7). Karyotype was 46XX. This patient's case was discussed pre-operatively at a Gynaecology Oncology MDT</div></div><div><h3>Comments</h3><div>The differential diagnosis for hyperandrogenism in the adolescent patient includes Polycystic Ovarian Syndrome, late-onset Congenital Adrenal Hyperplasia, and androgen-secreting tumours of the ovary or adrenal gland. Surgical findings were of an approximately 20cm right ovarian cyst with a solid component, and the patient underwent a right-salpingoophorectomy, complicated by intra-operative spillage of cyst contents. Histology revealed a juvenile granulosa cell tumour. She then had staging, including a CT TAP and completion surgery, including lymph node sampling, omentectomy, and appendicectomy. This confirmed a FIGO Stage 1C1 malignancy, and the patient received three cycles of Carboplatin Paclitaxal adjuvant chemotherapy. This case highlights the importance of considering malignancy in the differential diagnosis of an adolescent patient presenting with hyperandrogenism.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 235"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"43. Fetal cyst and follicular cyst in a neonate girl - treatment tactics","authors":"Inna Bachynska,&nbsp;Irina Gavrilova,&nbsp;Anna Kuzhnova,&nbsp;Ihor Mirochnyk,&nbsp;Tetiana Tymoshenko","doi":"10.1016/j.jpag.2025.01.076","DOIUrl":"10.1016/j.jpag.2025.01.076","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian cysts are common in fetuses and neonates and detected in up to 70% of cases on prenatal ultrasound. The size and appearance of cysts help to classify them as simple or complex indicating a physiologic cyst and ovarian torsion or hemorrhage, respectively. This case report presents conservative and operative tactics for the treatment of neonate's ovarian cysts.</div></div><div><h3>Case</h3><div>A girl was born at 35 weeks of gestation with an abdominal cystic mass measuring 38 mm in diameter detected on ultrasound at 32 weeks. The normal anatomy of other fetal abdominal organs suggested that an ovarian cyst was the most likely diagnosis. Ultrasound was performed every 4 weeks after birth. Two months after birth the USG shows bilateral ovarian cysts – complex at the left, simple at the right. At the age of three months, an abdominal ultrasound showed a right ovarian cyst of 58 × 56 × 62 mm and a left ovarian cystic mass was 44 × 42 × 42 mm with sediment, after that the patient was hospitalized. Operative treatment was chosen. Laparoscopy revealed necrotic antenatal torsion of the right adnexa with a right ovarian cyst and torsion of the left adnexa with a cyst. Adnexas were twisted between themselves twice. Removal of the right adnexa, adhesiolysis, detorsion of the left adnexa, aspiration of the left ovarian cyst, and biopsy of the left ovary were performed. Histological examination of the removed necrotized right ovary showed fragments of connective tissue with dyscirculatory changes, edema, hemorrhages, necrotic changes, foci of calcinosis. The biopsy of cyst revealed a small fragment of ovarian tissue with foci of edema and dystrophic stroma changes, several primordial follicles. The infant was discharged without any complications. Postoperative observation a month later detected a left ovarian cyst 31 × 27 × 35 mm in diameter at the right. Two months after the surgery the ultrasound reveled normal left ovary with follicles at its own place on the left.</div></div><div><h3>Comments</h3><div>Treatment of neonatal ovarian cysts must be determined according to the size of the ovarian cyst, clinical manifestation, and ultrasonographic findings. Conservative and operative management of ovarian cysts that appear complex on postnatal USG may lead to ovarian loss. Balanced determination of the tactics of managing simple ovarian cysts contributes to the preservation of ovarian tissue.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 249"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"52. Hysteroscopic metroplasty for use of intrauterine devices in adolescents and young adults","authors":"Erin Isaacson,&nbsp;Melina Dendrinos,&nbsp;John Randolph","doi":"10.1016/j.jpag.2025.01.085","DOIUrl":"10.1016/j.jpag.2025.01.085","url":null,"abstract":"<div><h3>Background</h3><div>There is no published literature on the use of hysteroscopic metroplasty in an adolescent or young adult (AYA) population, nor for the indication of desired intrauterine device (IUD) usage. We aimed to describe the usage of this procedure, which has historically been performed for reproductive concerns, in AYA with uterine septa who desired IUD insertion for dysmenorrhea, contraception, and heavy menstrual bleeding (HMB).</div></div><div><h3>Case</h3><div>All patients presented were diagnosed with a uterine septum when evaluating for a possible malpositioned IUD, and had either trialed systemic hormone management or had medical restrictions on hormonal treatment options. All previously placed IUDs were removed prior to surgical management. All metroplasties were performed using a bipolar Twizzle Tip electrode to incise the septum and all patients had uncomplicated placement of a 52-mcg IUD at time of metroplasty. A 15-year-old G0 with dysmenorrhea desired a hormonal IUD after failing combined hormonal methods. Her complete uterine septum was diagnosed via ultrasound after a string check raised concerns for a low-lying IUD. After counseling, she desired surgical removal of her septum to be eligible for repeat placement. After uncomplicated septum resection and IUD placement, she was seen for a one month post-operative visit without any reported irregular bleeding or pelvic pain. A 17-year-old G0 presented for HMB and dysmenorrhea. Her medical history included juvenile idiopathic arthritis and migraines with aura. After IUD placement, she underwent abdominal imaging for a weight loss work-up that noted a malpositioned IUD and uterine septum. After repeat counseling on available methods, she maintained that an IUD was best for her menstrual management. She underwent an uncomplicated septum resection and IUD placement, and was seen for follow-up at two months without further menstrual complaints. A 25-year-old G1P0010 with dysmenorrhea and HMB, with failure of two hormonal methods, had worsening dysmenorrhea after IUD placement. Pelvic imaging revealed a complete uterine septum with divergence of the lower segment into two separate cervixes. She underwent uncomplicated resection and IUD placement, as well as a laparoscopy to evaluate her dysmenorrhea. She was seen two months post-operatively with a significant improvement in menstrual symptoms.</div></div><div><h3>Comments</h3><div>This case series highlights the importance of metroplasty as a consideration for patients for whom an IUD is the preferential or only treatment option for a variety of gynecologic indications, especially for those unable to use other hormonal therapies secondary to side effects or co-existing conditions.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 254"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"51. Hypervascularized solid ovarian tumor, what a good surprise: ovarian sclerosing stromal tumor","authors":"Magdalena Castro ,&nbsp;Carolina Pastene ,&nbsp;Mónica Muñoz ,&nbsp;Constanza ralph ,&nbsp;Maria Alejandra Delgado ,&nbsp;Paloma Gomez ,&nbsp;Isabel Fuentealba","doi":"10.1016/j.jpag.2025.01.084","DOIUrl":"10.1016/j.jpag.2025.01.084","url":null,"abstract":"<div><h3>Background</h3><div>Sclerosing stromal tumor (SST) is a rare benign sex cord-stromal tumor (SCST) of the ovary, accounting for less than 5% of all ovarian SCST cases. We aim to present a case where a solid ovarian tumor, initially suspected as malignant due to imaging findings, was ultimately diagnosed as a benign SST in a postmenarcheal adolescent.</div></div><div><h3>Case</h3><div>A 14-year-old girl with a history of medulloblastoma, treated with chemotherapy and radiotherapy, was under endocrine care for severe short stature. A pelvic ultrasound revealed a solid, homogeneous, hypervascularized tumor in the left ovary (18 cc), without cystic areas or calcifications. CT confirmed a well-defined, hyperenhancing mass (27 × 49 × 32 mm) in the left adnexa, displacing nearby structures. Tumor markers were negative: LDH 285 U/L, BhCG &lt; 2.4 mIU/mL, Alpha Feto protein &lt; 2 ng/mL, Anti-Mullerian hormone 0.77 ng/mL, Ca 125 32.8 U/mL, Ca 19-9 20.7 U/mL, CEA 2.7 ng/mL. Laparoscopic left adnexectomy was performed, and histopathology confirmed an ovarian SST. The patient's recovery was favorable, and no malignancy was detected. This case was reviewed and approved by the Ethics Committee of Hospital Dr. Luis Calvo Mackenna.</div></div><div><h3>Comments</h3><div>Despite the low incidence of SST, particularly in young girls, its clinical and imaging findings can mimic malignancy. This case underscores the importance of imaging and histopathology for diagnosis. MRI may help identify benign features and avoid overtreatment, preserving fertility. The benign nature of the tumor provided reassurance to the patient and her family. Financial Disclosure: The authors have no financial relationships relevant to this case to disclose.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 253"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"17. Bilateral Antenatal Ovarian Torsion with Autoamputation: A Case Report","authors":"Blaire Scott ,&nbsp;Kiki Greene ,&nbsp;Alejandro Ruiz-Elizalde ,&nbsp;Lisa Moon","doi":"10.1016/j.jpag.2025.01.050","DOIUrl":"10.1016/j.jpag.2025.01.050","url":null,"abstract":"<div><h3>Background</h3><div>While antenatal and neonatal ovarian cysts (OC) typically resolve spontaneously, a minority will result in torsion; when this occurs in utero, there is a higher risk of autoamputation (AA) than in postnatal patients due to delay in intervention. In one case series of 28 patients diagnosed with antenatal ovarian torsion (AOT), 60% had AA of the affected adnexa; however, all of them were unilateral. We present a case of an infant with bilateral AOT resulting in AA.</div></div><div><h3>Case</h3><div>IRB exempt status was confirmed through our IRB process. Antenatal ultrasound (US) at 33w1d found bilateral OC, with right simple cyst measuring 2 cm and left complex cyst measuring 4 cm. She was born at term via vaginal delivery. US on day of birth showed both OC stable in size and appearance; no normal ovarian tissue visualized. Tumor markers were normal range. She had normal external female genitalia. Repeat US at 1 week of life showed the left complex cyst stable, and the right cyst smaller. Repeat US at 1.5 months demonstrated the same complex cyst stable in size but now located on the right, and the previously seen right cyst resolved; no identifiable ovarian tissue. She was asymptomatic throughout. Due to persistence and complexity, decision was made to proceed with diagnostic laparoscopy, performed at age 3 months. Intraoperatively she was found to have a normal uterus but no identifiable left ovary or fallopian tube (FT), with a 4 cm cystic structure floating on the right but connected to the left infundibulopelvic (IP) ligament by a thin band of tissue, consistent with AA of the left adnexa. This was removed and on pathology there was no viable tissue. The right FT was truncated at the ampulla with no identifiable fimbria, no identifiable right ovary. Superior to the end of the right FT and above the pelvic brim, a 5 mm piece of white tissue was attached to the peritoneum on the side wall, not connected to the right IP or utero-ovarian ligaments, presumed to be what remains of the right adnexa. Given possibility of viable tissue, decision was made to leave this in place; biopsy was not attempted due to concern for damaging the small amount of tissue remaining.</div></div><div><h3>Comments</h3><div>Antenatal OC are becoming a more common finding with advances in antenatal US imaging, however the incidence of AOT is rare. Most literature reports on postnatal monitoring techniques and leans toward conservative management in most cases. Our case presents a unique situation in which earlier intervention might have outweighed the risk of surgery to potentially preserve ovarian tissue, and would suggest consideration for earlier surgical intervention in cases where bilateral adnexal masses are present.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 237-238"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Your Head Spinning? Science, Politics, and Our Journal","authors":"Paula J Adams Hillard MD (JPAG Editor-in-Chief)","doi":"10.1016/j.jpag.2025.02.004","DOIUrl":"10.1016/j.jpag.2025.02.004","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 101-102"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2. A Dual Diagnosis: The Rare Connection Between Pelvic Tuberculosis and Yolk Sac Tumor","authors":"Kendall Bielak ,&nbsp;Ellen Myers ,&nbsp;Vasiliki Anemikos ,&nbsp;Vrunda Patel","doi":"10.1016/j.jpag.2025.01.035","DOIUrl":"10.1016/j.jpag.2025.01.035","url":null,"abstract":"<div><h3>Background</h3><div>We present a case of intra-abdominal tuberculosis and ovarian yolk sac tumor in an adolescent. It highlights the challenges of overlapping genetic, infectious, and autoimmune factors in adolescents and the importance of multidisciplinary care in patients with rare diagnoses and balancing treatment with long-term quality of life.</div></div><div><h3>Case</h3><div>A 17-year-old female presented to the emergency room with a one-week history of abdominal distension; imaging demonstrated a 4 cm cystic pelvic mass with carcinomatosis and large volume ascites. Tumor markers showed a normal alpha-fetoprotein (AFP) of &lt; 0.8, borderline lactate dehydrogenase (LDH) of 292, and an elevated CA-125 of 400. The histopathology from diagnostic laparoscopy of the omentum, peritoneum, and ovaries showed necrotizing granulomatous inflammation without malignancy. The patient received a rheumatologic, infectious, and genetic workup; positive Acid-Fast Bacilli cultures confirmed mycobacterial tuberculosis infection. She completed rifampin, isoniazid, pyrazinamide, ethambutol therapy 6 months later. Somatic genetic testing revealed a Nucleotide Binding Oligomerization Domain 2 (NOD2) mutation, which may have contributed to granulomatous disease, although the clinical significance was uncertain. One year later, she presented with abdominal pain; imaging revealed a 12 cm pelvic mass with retroperitoneal lymphadenopathy. Tumor markers were elevated with AFP &gt; 1150 and LDH 801, suggesting a malignant process. She experienced acute worsening pain, and CT confirmed spontaneous rupture of the mass. She underwent exploratory laparotomy, unilateral salpingoophorectomy, and omentectomy with gynecology oncology. Pathology revealed a FIGO Stage IIB yolk sac tumor involving the left ovary with abundant necrosis. Omentum, peritoneum, and additional biopsies showed reactive changes without tumor involvement. She initiated chemotherapy with Bleomycin, Carboplatin, and Etoposide, and underwent three cycles without complications. At follow-up with pediatric gynecology, she showed no evidence of premature ovarian insufficiency and started on Slynd for menstrual management and contraception.</div></div><div><h3>Comments</h3><div>This case highlights the complexities adolescents face when undergoing treatment for rare disease processes and genetic mutations of uncertain clinical significance. NOD2 may play a role in carcinogenesis as a tumor suppressor and is linked to mycobacterial infections. This case highlights the importance of ongoing research of rare disease presentations and genetic variants as well as the importance of multidisciplinary care in adolescents with rare diagnoses at risk for decreased ovarian function.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 230"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}