Part 25. Gynecologic Problems in Childhood
Chapter 503. Vulvovaginitis
-M/C childhood & adolesent
gynecologic problem
(Cl/M)
--Physiologic vaginal discharge
menarche가 시작되기 6-12개월 전에
vaginal discharge 가 정상적으로 증가됨.
특징:
yellowish
no spesific malodor
vulva is not inflamed
주로 Doderlein's bacilli로 구성됨
Pathologic Vaginal Discharge
primary
sx. of vulvitis, vaginitis, or vulvovaginitis
associated
sg. & sx.
:pruritis, frequent urination,
dysuria, enuresis
Nonspecipic Vulvovaginitis
#
70% of all pediatric vulvovaginitis case
#
discharge
; brown or green
;
fetid odor
;
asso. with a vaginal pH.4.7-6.5
#원인균
; *Coliform bacteria(68%) - ▲common
; β-hemolytic
streptococcus, coagulase positive staphylococcus
#
★Treatment
; perineal hygiene
; switching from
tight-fitting underwear
; use of sitz baths with mild
soap
; air drying the vulva
; systemic antibotics
-
recurrent vulvovaginitis인 경우
-
amoxicillin or cephalosporins
; *topical estrogens or polysporin ointment
Specific Vulvoviginitis
# ★Gardnerella
vaginitis
-
*▲common
# candida - second
# others
; peptococcus, peptostreptococcus, veillonella parvula, eubacterium, propionibacterium, bacteroides species
; protozoa, helminths, virus
★Table
503-1
Labial Adhesions
Candidiasis
Diaper Dermatitis
Molluscum Contagiosum
Intertrigo
Impetigo
Pitryasis Versicolor
# Causes
;
*pityrosporum orbiculare
# Clinical Manifestation
;
*scaly macules on trunk
- sometimes on face, genial lesions
# Diagnosis
; visualization on wet prep of hyphae and spores with 10% potassium hydroxide
# Treatment
;
*topical imidazoles
Herpes Simplex Virus
Hyman Papilloma Virus
# serotypes
;
*6, 11, 16, 18
-
*16, 18 : asso. with malignant and
premalignant lesion
Lichen Sclerosus
; onic atrophic skin disease
; small, pink to ivory, flat-topped papules
- several millimeters in diameters
; coalesce into plaques
; ★“hourglass”
or “figure 8” features in anogenital lesion
Lichen Planus
Lichen Simplex Chronicus
Seborrheic Dermatitis
Atopic Dermatitis
Contact Dermatitis
Vulvar Psoriasis
Chapter 504. Bleeding
#
★Causes
; exposure sex steroids
; foreign body
; hemorrhagic cystitis
; hypothyrodism
; precocious puberty
; presence of an ovarian cyst
; trauma asso. with sexual
abuse
; urethral prolapse
; vulvovaginitis
;
neoplasms
-
rhabdomyosarcoma, clear cell sarcoma, endodermal sinus tumors, mesonephric
carcinoma
Chapter 505. Breast Disorder
Congenital Anomalies
--amastia : rare, unilateral
asso. with other anomalies
* Doland
syndrome
-
aplasia of the pectoralis m.
rib deformities
webbed finger, radial nerve aplasia
--Polymastia (supernumeray
breast's and supernumerary nipple(polythelia)
: relatively common
along the midline
usually asymptmatic
--hypoplasia of the breasts
:cause: 1. delayed
onset of breast development
2, family history of late breast develoment
3. suppressed or failed ovarian function
Breast Mass
retrospective review of
breast ds, in adolesent female
1. fibroaenoma 54%
2. vaginal hypertrophy 13%
3. fibrocytic or proliferative breasrt ds. 24%
4. primary and metastatic Rabdomyosarcoma, metastatic neuroblastoma.
non-Hodgkin's lymphoma 2-3%
Malignant Tumor Of Breast
rare occur in
adolescent
1. Cystosarcoma phylloides
uncommon
firm,mobile
circomscribed mass
2. radiation induced sarcoma
3. liphosarcoma
4. extramedulllary
manifestation of ALL
Macromastia (Vaginal Hypertrophy)
- etiology is unknown
but probably due to endodrgan increased sensitivity
to circulating
estrogen
- bilateral
- 13-17 yr old most
commonly
Nipple Discharge
#
galactorrhea
; ★Causes
-
prolactinoma
-
hypothyroidism
#
hyperprolactinemia가 관찰되면 증상에 관계없이 brain imaging studies
Chapter 506. Hirsutism And Polycystic Ovarian Sydrome
Excessive Androgen Production Prior To Puberty
#
Hirsutism(excessive hair growth) 은 virilization과 구별되어야
된다.
;
Virilization
-
*increase body hair, acme, voice
change, change in body habitus. due to increased musle mass, clitomegaly
;
Premature pubarche
-
appearance of genital hair or axillary hair or both before 8yr of age
; Adrenarche
-
*output of excess androgen from the
adrenal gland
- usually occurs between 12 and 18 yr of age
Hirsutism In The Adolescent
Table 506-1
Hair- An Syndrome
: the acrom for
the association of hirsutism, androgen excess.
insulin resistance and acanthosis nigricans
: pathogenesis
is unknown
Hyperprolactnemia
때로
hyperandrogenemia의 원인이 되기도 하는 CNS disorder(see
Chapter 517)
hyperprolactinena있는
40%에서 androgen abnormality 를 나타낸다.
lab,.finding ;
1. free testotosterone 증가
2 adrenal production of 17
hydroxyprogesterone and androstenedione 증가
Polycystic Ovary Synd. (Chronic Anovulation .
Stein-Levental Syndrome)
; *▲common ovarian cause of
hirsutism
; Laboratory Finding
-
altered LH release
/
*LH to FSH rateio of 2:1 or 3:1
/
*shortened pulse frequency, increased
amplitude of LH
Treatment Of Hirsute Patient
- Tx. of idiopathiand
and PCO ; Table 506-2
- Tx. of Hirsutism 2nd
to hyperprolactinemia ;Bromocriptine
Chapter 507. Neoplasms
-most common gynecologic
neoplasm in children is of ovrian
Ovaries
-18세 이하에서 pevic tumor의 발생순서
1. ovarian tumor :M/C
2. paraovarian tumor
3. uterine tumor
-clinical manifestation :abd. pain
and mass
-사춘기에서 가장 흔한 ovarian tumor 2가지
1. teratoma
2. ovarian adenoma
* Teratoma of adenoma
: usually benign but
rarely malignant
calcification on abd. X-ray is hallmark of benign teratoma
-ovarian tumor 의 대부분은
Germ cell type이다.
* germ cell tumor of ovary 의 발생순서
1. dysgerminoma
2. malignant teratoma
3. endodermal sinus tumors
4. embryonal carcinomas
5. mixed cell neoplasms
Ovarian Follicular Cyst
: occur from birth to
puberty
보통
3-32주 인에 저절로 없어짐
Autoamputation Of The Ovary
: present as small
calcified free - floating mass associated with absent adnexa
: maybe asymptomatic
: 진단에는
ultrasound 가 적합
- Sex cord stromal tumor : 5% of
ovarian neoplasm
M/C : grannulosa cell
tumor
Cervix
; prevalence of dysplasia and
Ca-in-situ : 18.8/1000 for age
15-19 yr
;
cervical intraepithelial neoplasia(CIN)
-
sexually activie한 teenage나
young adolt에서 간혹 진단되어짐
- 소아 영역에서는 very rare
Cha pter 508. Developmental Anomalies
(embryology)
- uterus ; formed by fusion
of the cordal elements of the mullerian ducts
at and 8 wk of gestation
-vagina : the terminal
portion of the uterovaginal canal( Mullerian origian) 에서 형성이
시작되어
--- posterior aspect of the urogenital sinus와 만나서
vagina형성
이렇게
Mullerian duct 의 fusion 과정에 생기는 여러가지
anomaly 등이 있다.
* Table 508-1,
508-2
Chapter 509. Athletics
* 여자 운동선수들에게 생길 수 있는 gynecologic problems
1. delayed menarche
- average
age of onset of menarche is 12.23 yr
- athlets의 경우
: 13.58 yr
2. menstrual irregularity
주로
oligo menorrhea or amenorrhea 의 형태
3. endocrinologic change
-
hypoestrogenism
- FSH to LH
ratio 의 변화
4. premature bone loss
Chapter 511. Gynecologic Imaging
(신판 추가)
1. transabdominal approach
with use of a distended b;adder
- 7.5 or 5MHz
transducer 사용
* Table
511-1,511-2
* pelvic mass 의
cause
1. ovarian cyst
2. hydrocolpos--dilation of the vagina
3. hydrometroco;pos--dilatation of the uterus and the vagina
2. ultrasound - a key
screening tool
3. MRI/CT - for further
assessment