Journal of pediatric and adolescent gynecology最新文献

{"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":"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":"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}

{"title":"35. Estimated blood loss and safety by technique for longitudinal vaginal septum excision","authors":"Leandra Cole ,&nbsp;Elizabeth Boskey ,&nbsp;Ava Scatoni ,&nbsp;Jessica Shim","doi":"10.1016/j.jpag.2025.01.068","DOIUrl":"10.1016/j.jpag.2025.01.068","url":null,"abstract":"<div><h3>Background</h3><div>Longitudinal vaginal septum (LVS) is a congenital anomaly that may be excised in adolescents with symptoms such as tampon difficulty. Several techniques for surgical excision exist, including excision with cautery or a bipolar electrosurgical instrument. Our study objective was to evaluate if any difference in blood loss or postoperative complications existed between excision with Bovie® cautery versus with the LigaSure™ vessel sealing device. We hypothesized that blood loss and complications were low with both surgical techniques.</div></div><div><h3>Methods</h3><div>This was a retrospective study of all patients who underwent LVS excision at a single pediatric tertiary care institution under the care of the Pediatric and Adolescent Gynecology division from 2012 to 2024. Patients either underwent excision using cautery or a vessel sealing device; the vaginal mucosa was oversewn after either technique. Demographics, clinical characteristics, estimated blood loss, and postoperative complications were abstracted from the medical chart. This study was approved by the Institutional Review Board.</div></div><div><h3>Results</h3><div>44 patients underwent excision of LVS during the study time period, mean age 17 years. The most common presenting symptom was tampon difficulty (52%) followed by dysmenorrhea (39%), and dyspareunia (9%). Eleven percent had no symptoms reported. The majority of patients (84%) had 2 cervices; 7 (16%) had 1 cervix. Thirty-two patients (73%) underwent cautery, 11 (25%) underwent vessel sealing, and 1 (2%) both. Mean blood loss was not significantly different with both techniques (13 vs. 4 ml, p=.10). Postoperative complications were rare. 7 (16%) patients presented to the emergency department (ED), average 12 days post-surgery. Of these 7 patients, 3 presented for vaginal bleeding, 1 for vaginal discharge, 3 for symptoms deemed unrelated to surgery by the ED. One patient underwent emergent revision due to an estimated 400 ml blood loss prior in the ED, with 100 ml blood evacuated in the OR and 10 ml active blood loss with the revision. Of the 3 patients who presented to the ED for bleeding concerns, 2 underwent cautery, and 1 underwent vessel sealing device.</div></div><div><h3>Conclusions</h3><div>The overall blood loss at time of surgery for LVS was low and did not significantly differ by surgical technique, although there was a trend towards less blood loss with vessel sealing that might become significant with a larger sample. Postoperative complications were also rare with either method, though 2 patients (4%) experienced unanticipated problems – one significant interoperative tissue friability and the other bacterial vaginosis. Surgeons may consider using several techniques to safely perform LVS excision.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 246-247"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519882","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":"9. Abdominopelvic Pain and Coexisting Pain Disorders in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome","authors":"Samantha Lowe ,&nbsp;Sara Vincent ,&nbsp;Megan Sumida ,&nbsp;Jennifer Dietrich","doi":"10.1016/j.jpag.2025.01.042","DOIUrl":"10.1016/j.jpag.2025.01.042","url":null,"abstract":"<div><h3>Background</h3><div>Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH) is a congenital anomaly in which the Mullerian duct is underdeveloped, leading to absence of the uterus and vagina. Limited research exists describing abdominopelvic pain (AP) in women with MRKH, with most studies focusing solely on pain related to sexual function. Our objectives were to: 1) estimate the prevalence of AP in women with MRKH, 2) compare the prevalence of AP in women with anatomic variations and extragenital anomalies in MRKH, and 3) estimate the prevalence of coexisting pain disorders (CPD) in women with MRKH.</div></div><div><h3>Methods</h3><div>We conducted an IRB-approved retrospective cohort study of patients with MRKH seen at an academic center between 8/20/2014 – 8/20/2024. Patients were identified using ICD-10 codes for agenesis of uterus or agenesis of vagina. Inclusion criteria were as follows: 1) patients with a confirmed diagnosis of MRKH, as assessed by post-pubertal MRI or surgical findings. Patients with abnormal karyotypes were excluded. Data included demographics, MRKH type and associated extragenital malformations, presence of uterine remnants (UR), pelvic pathology, presence and quality of AP, and CPD. Persistent AP was defined as pain lasting more than six months or occurring at intervals which spanned over a period longer than six months. Cyclic AP was defined as pain occurring at monthly intervals for any time period. Persistent and cyclic AP were not mutually exclusive. Chi-square and t-test statistics were performed.</div></div><div><h3>Results</h3><div>117 patients were identified and then subcategorized into those with UR (N=63) and those without UR (N=54) and separately evaluated by MRKH type (Type 1 N=65, Type 2 N=52). Overall, 43 patients (36.8%) reported persistent AP and 24 patients (20.5%) reported cyclic AP. Presence of UR was associated with both the presence of persistent AP (p = 0.008) and cyclic AP (p = 0.001) (Table 1). There was no association between the type of MRKH and the presence of persistent AP (p = 0.732) or cyclic AP (p = 0.282) (Table 2). 28 (23.9%) patients were diagnosed with or treated for one or more CPD, with migraine headache (21/117) and IBS (8/117) being the most common. Secondarily, MRKH patients had a wide range of pelvic pathologies, including ovarian cysts (14/117), paratubal cysts (15/117), and endometriosis (3/117). Endometriosis may be underestimated due to need for surgical diagnosis.</div></div><div><h3>Conclusions</h3><div>In this cohort of women with MRKH, over a third of patients reported persistent AP. Persistent AP and cyclic AP were associated with the presence of UR and MRKH types with AP were similar. The limited number of MRKH patients with CPD may reflect overlapping diagnoses.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 233-234"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519933","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":"15. Surgical management of ovarian dermoid cysts in children: a systematic review and meta-analysis","authors":"Nicole Smith ,&nbsp;Justin Lim ,&nbsp;Carolyn Ziegler ,&nbsp;Lisa Allen ,&nbsp;Andrea Simpson ,&nbsp;Sari Kives","doi":"10.1016/j.jpag.2025.01.028","DOIUrl":"10.1016/j.jpag.2025.01.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Ovarian dermoid cysts are benign germ-cell tumors commonly found in pediatric and adolescent patients. Laparoscopic ovarian cystectomy has become the preferred surgical approach over laparotomy due to its benefits of shorter hospital stay, reduced post-operative pain, and quicker recovery. However, there remains concern for higher rates of cyst rupture (and possible peritonitis) and future dermoid cyst recurrence, when compared to laparotomy. This systematic review and meta-analysis evaluates the existing evidence on these surgical methods to assess whether the shift to laparoscopy has led to these unintended outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A comprehensive literature search in five academic medical databases was conducted with an information specialist, using keywords and MeSH terms for ovarian dermoid cysts, laparotomy, laparoscopy, or minimally invasive surgery in children, from database inception to August 29, 2024. This study was exempt from Research Ethics Board (REB) approval. Randomized, quasi-randomized trials, and prospective/retrospective cohort studies were eligible. Two independent authors reviewed titles/abstracts, full texts, and extracted data, resolving conflicts with a third author as required. Risk of bias was assessed with appropriate tools. A meta-analysis using risk ratios with 95% confidence intervals was performed with a Mantel-Haenszel fixed-effect model. Heterogeneity among studies was assessed by I², with I2 &gt; 50% interpreted as high degree of heterogeneity requiring random-effects modelling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;1021 title/abstracts were reviewed, with six studies eligible for inclusion (2000 – 2022; Canada, United States, Poland). In total, 492 (58%) patients underwent laparoscopy and 353 (42%) underwent laparotomy. For meta-analysis, five studies were included for cyst rupture and four studies were included for dermoid cyst recurrence. Random-effect meta-analysis (I2=58%) showed a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47, 95% CI 1.40-4.37). Four studies reported on peritonitis, with no cases observed. Fixed-effect meta-analysis (I2 =5%) found no significant difference in dermoid cyst recurrence between laparoscopy and laparotomy (RR = 0.92, 95% CI 0.41-2.08).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Laparoscopy remains the preferred approach for the surgical management of ovarian dermoid cysts in children. Despite a higher risk of intraoperative cyst rupture, our systematic review highlights that&lt;/div&gt;&lt;div&gt;subsequent post-operative peritonitis was not clinically observed. Further, dermoid cyst recurrence rates remained similar between laparoscopy and laparotomy, further encouraging the use of laparoscopy when possible. Limitations of our systematic review include the limited number of included studies, all of which were observational studies with small sample sizes, and the presence of unaccounted confounders such as cyst size,","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 228-229"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520011","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":"14. An Unusual Case of Hematometrocolpos in a Young Patient with Acute Myeloid Leukemia","authors":"Rabab Isa ,&nbsp;Noor Zwayne","doi":"10.1016/j.jpag.2025.01.047","DOIUrl":"10.1016/j.jpag.2025.01.047","url":null,"abstract":"<div><h3>Background</h3><div>Hematometra and hematocolpos are uncommon conditions involving fluid accumulation in the uterus and vagina, often due to primary or secondary outflow obstruction. Their occurrence in young patients, particularly those with hematologic disorders, poses diagnostic challenges and can lead to significant morbidity. This case report aims to enhance awareness of acquired hematometrocolpos resulting from graft versus host disease (GvHD) in a post-hematopoietic stem cell transplant patient.</div></div><div><h3>Case</h3><div>A 17-year-old female with a history of acute myeloid leukemia presented with severe pelvic pain after treatment for cancer, GvHD, and premature ovarian insufficiency. Evaluation revealed significant hematocolpos and a distended uterus to 16 cm. Diagnostic laparoscopy and hysteroscopy identified atrophic vaginal and cervical tissues with substantial adhesions. Approximately 300 cc of dark blood was drained, and a levonorgestrel-releasing intrauterine device was placed. Despite initial improvement, the patient experienced recurrent hematocolpos requiring repeat surgical decompression. She is currently doing well with vaginal estrogen and dilators to maintain patency.</div></div><div><h3>Comments</h3><div>This case highlights consideration of hematometrocolpos in adolescents with complex medical histories, particularly those undergoing treatment for hematologic malignancies. Early recognition and intervention can prevent long-term complications and improve patient outcomes. Continued education on the implications of GvHD on the female genital tract is essential for optimizing care in this vulnerable population.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 235-236"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520016","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":"1. A Novel Ovarian Reserve Monitoring Algorithm for Patients at Risk of Ovarian Injury from Gonadotoxic Therapy","authors":"Guluzar Turan ,&nbsp;Victoria Kennerley ,&nbsp;Marie-Teresa Colbert ,&nbsp;Marcy Hoath ,&nbsp;Kamilah Abdur-Rashid ,&nbsp;Mikayla Ecker ,&nbsp;Mary Sammel ,&nbsp;Leslie Appiah","doi":"10.1016/j.jpag.2025.01.013","DOIUrl":"10.1016/j.jpag.2025.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent and young adult cancer survivors are at risk of infertility due to the gonadotoxic effects of treatment. Although ovarian function testing (OFT) is an essential aspect of fertility care, there is currently no standard of care for monitoring reserve after gonadotoxic therapy. At our institution, we measure AMH and FSH at 12-, 18-, and 24-months post-therapy for early detection of DOR (diminished ovarian reserve) and POI (premature ovarian insufficiency) to avoid delays in referral for assisted reproductive technologies (ART). The primary objective of this study is to assess whether a novel ovarian reserve monitoring algorithm enables early detection of DOR and POI after gonadotoxic therapy to improve reproductive outcomes.</div></div><div><h3>Methods</h3><div>In this IRB-approved observational cohort study at University of Colorado Hospital, we evaluated the algorithm to (1) identify survivors at risk of DOR and POI due to gonadotoxic therapy and (2) minimize time from treatment to ART. Group A (n=106) consisted of a retrospective cohort of survivors who completed therapy between October 1, 2016, and September 31, 2019, with AMH and FSH evaluated at 12, 18, and 24 months post-treatment completion (n=27). Group B (n=418) included survivors who completed cancer therapy after September 31, 2019, assessed prospectively at similar time points (n=64). AMH and FSH values, along with time since treatment, were analyzed to determine if the algorithm enables early detection of DOR before POI. Ovarian status was categorized as normal, diminished, impending POI, or POI. Time from treatment to diagnosis of DOR and POI was compared between the prospective group and historical controls using the log-rank test.</div></div><div><h3>Results</h3><div>Demographics between groups A and B were similar. OFT within 36 months after completing cancer treatment was performed in only 17.4% (91/524) of patients, and AMH was rarely tested before 2019. At the 24-month follow-up, the prospective group had a higher prevalence of normal ovarian reserve (44.3% [27/61] vs. 17% [4/23], p=0.05) compared to the retrospective group. Time from treatment to diagnosis of DOR or POI was shorter in Group B, although not significantly due to the small sample size (8.2 months in group A [n=19] vs. 6.1 months in group B [n=24], p=0.7).</div></div><div><h3>Conclusions</h3><div>Results suggests that patients followed under the fertility preservation program since 2019 have received more frequent monitoring and earlier OFT with increased use of AMH testing to detect changes before significant decline. The ovarian reserve monitoring algorithm allows early detection of DOR and POI after gonadotoxic therapy, potentially improving reproductive outcomes.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 219"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520095","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}