Part 25. Gynecologic Problems in Childhood
Chapter 503. Vulvovaginitis
-M/C childhood & adolesent
gynecologic problem
(Cl/M)
--Physiologic vaginal discharge
menarche°¡ ½ÃÀ۵DZâ 6-12°³¿ù Àü¿¡
vaginal discharge °¡ Á¤»óÀûÀ¸·Î Áõ°¡µÊ.
Ư¡:
yellowish
no spesific malodor
vulva is not inflamed
ÁÖ·Î Doderlein's bacilli·Î ±¸¼ºµÊ
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
#¿øÀαÕ
; *Coliform bacteria(68%) - ¡ãcommon
; ¥â-hemolytic
streptococcus, coagulase positive staphylococcus
#
¡ÚTreatment
; perineal hygiene
; switching from
tight-fitting underwear
; use of sitz baths with mild
soap
; air drying the vulva
; systemic antibotics
-
recurrent vulvovaginitisÀÎ °æ¿ì
-
amoxicillin or cephalosporins
; *topical estrogens or polysporin ointment
Specific Vulvoviginitis
# ¡ÚGardnerella
vaginitis
-
*¡ãcommon
# candida - second
# others
; peptococcus, peptostreptococcus, veillonella parvula, eubacterium, propionibacterium, bacteroides species
; protozoa, helminths, virus
¡ÚTable
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
; ¡Ú¡°hourglass¡±
or ¡°figure 8¡± features in anogenital lesion
Lichen Planus
Lichen Simplex Chronicus
Seborrheic Dermatitis
Atopic Dermatitis
Contact Dermatitis
Vulvar Psoriasis
Chapter 504. Bleeding
#
¡ÚCauses
; 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
; ¡ÚCauses
-
prolactinoma
-
hypothyroidism
#
hyperprolactinemia°¡ °üÂûµÇ¸é Áõ»ó¿¡ °ü°è¾øÀÌ brain imaging studies
Chapter 506. Hirsutism And Polycystic Ovarian Sydrome
Excessive Androgen Production Prior To Puberty
#
Hirsutism(excessive hair growth) Àº virilization°ú ±¸º°µÇ¾î¾ß
µÈ´Ù.
;
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
¶§·Î
hyperandrogenemiaÀÇ ¿øÀÎÀÌ µÇ±âµµ ÇÏ´Â CNS disorder(see
Chapter 517)
hyperprolactinenaÀÖ´Â
40%¿¡¼ androgen abnormality ¸¦ ³ªÅ¸³½´Ù.
lab,.finding ;
1. free testotosterone Áõ°¡
2 adrenal production of 17
hydroxyprogesterone and androstenedione Áõ°¡
Polycystic Ovary Synd. (Chronic Anovulation .
Stein-Levental Syndrome)
; *¡ãcommon 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
-18¼¼ ÀÌÇÏ¿¡¼ pevic tumorÀÇ ¹ß»ý¼ø¼
1. ovarian tumor :M/C
2. paraovarian tumor
3. uterine tumor
-clinical manifestation :abd. pain
and mass
-»çÃá±â¿¡¼ °¡Àå ÈçÇÑ ovarian tumor 2°¡Áö
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 ÀÇ ´ëºÎºÐÀº
Germ cell typeÀÌ´Ù.
* germ cell tumor of ovary ÀÇ ¹ß»ý¼ø¼
1. dysgerminoma
2. malignant teratoma
3. endodermal sinus tumors
4. embryonal carcinomas
5. mixed cell neoplasms
Ovarian Follicular Cyst
: occur from birth to
puberty
º¸Åë
3-32ÁÖ Àο¡ ÀúÀý·Î ¾ø¾îÁü
Autoamputation Of The Ovary
: present as small
calcified free - floating mass associated with absent adnexa
: maybe asymptomatic
: Áø´Ü¿¡´Â
ultrasound °¡ ÀûÇÕ
- 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 activieÇÑ teenage³ª
young adolt¿¡¼ °£È¤ Áø´ÜµÇ¾îÁü
- ¼Ò¾Æ ¿µ¿ª¿¡¼´Â 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) ¿¡¼ Çü¼ºÀÌ
½ÃÀ۵Ǿî
--- posterior aspect of the urogenital sinus¿Í ¸¸³ª¼
vaginaÇü¼º
ÀÌ·¸°Ô
Mullerian duct ÀÇ fusion °úÁ¤¿¡ »ý±â´Â ¿©·¯°¡Áö
anomaly µîÀÌ ÀÖ´Ù.
* Table 508-1,
508-2
Chapter 509. Athletics
* ¿©ÀÚ ¿îµ¿¼±¼öµé¿¡°Ô »ý±æ ¼ö ÀÖ´Â gynecologic problems
1. delayed menarche
- average
age of onset of menarche is 12.23 yr
- athletsÀÇ °æ¿ì
: 13.58 yr
2. menstrual irregularity
ÁÖ·Î
oligo menorrhea or amenorrhea ÀÇ ÇüÅÂ
3. endocrinologic change
-
hypoestrogenism
- FSH to LH
ratio ÀÇ º¯È
4. premature bone loss
Chapter 511. Gynecologic Imaging
(½ÅÆÇ Ãß°¡)
1. transabdominal approach
with use of a distended b;adder
- 7.5 or 5MHz
transducer »ç¿ë
* Table
511-1,511-2
* pelvic mass ÀÇ
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