Pre-operative differentiation of pediatric ovarian tumors: morphological scoring system and tumor markers.

OBJECTIVE: To investigate the importance of morphological scoring systems in differentiation of ovarian tumors in childhood. METHODS: Morphological assessment using DePriest's index was performed for all patients with histopathological confirmation of ovarian tumor, with evaluation of tumor markers, from January 1997. RESULTS: Fifty-three girls (age range 13 months to 19 years) were surgically treated for 59 ovarian tumors, including six bilateral. All lesions with cystic appearance on ultrasonography were benign, 23 of 35 semisolid, and four of ten solid tumors were also benign. Stage of malignant disease was as follows: stage I, ten; stage II, two; stage III, six. Sensitivity, positive predictive value and accuracy by DePriest's and Ueland's indexes for benign tumors (score <7) were: 0.88, 0.79; 0.89; and 0.94, 0.84; 0.93; respectively. Elevated levels of tumor markers were observed in 17 patients, including four patients with endocrine manifestations. In 24 patients ovaries were successfully preserved, including two patients with foci of immature teratoma in a dermoid cyst. CONCLUSION: Ultrasonographic assessment with morphological analysis recommended by DePriest and Ueland is a very useful procedure for differentiating benign from malignant ovarian tumors in children. Tumor markers and endocrinological investigation are also useful for preoperative evaluation.

[Ovarian cysts and tumors as the cause of isosexual pseudoprecocious puberty].

INTRODUCTION: Precocious puberty in girls is generally defined as appearance of secondary sexual characteristics before eight years of age. Menarche before the ninth birthday may serve as an additional criterion. Precocious puberty is divided in central precocious puberty and pseudoprecocious puberty. Central precocious puberty (GnRH dependent) occurs because of premature activation of hypothalamic-pituitary-gonadal axis and activity of gonadotrophins. Pseudoprecocious puberty (GnRH independent) is caused by activity of sexual steroids that are not the result of gonadotrophin activity. OBJECTIVE: Objective of our study was to examine the etiology, clinical and laboratory manifestations of isosexual pseudoprecocious puberty in girls. METHOD: In the period between 1995 and 2004, clinical and laboratory sings of 34 girls with precocious puberty were studied at the Endocrine Department of the Institute of Mother and Child Health Care of Serbia. Initial evaluations included height measurement, staging of puberty, bone age assessment and pelvic ultrasound. Important diagnostic sonographic parameters of precocious puberty were the volumes of ovaries and uterus as well as ovarian structure. The initial hormonal evaluation included measuring of plasma oestradiol, luteinizing hormone (LH) and follicle stimulating hormone (FSH). The luteinizing hormone releasing hormone (LHRH) stimulation test was used to evaluate LH and FSH responsiveness (60 microg/m2 LHRH-Relefact LHRH, Ferring). Blood samples were collected at 0, 20 and 60 minutes. Basal and GnRH stimulated LH and FSH were determined by immunoradiometric assay. Estradiol concentration was measured using the fluoroimmunometric assay. RESULTS: Thirty-four girls aged 6 months to 9 years (mean age 4.5 years) with precocious puberty were studied during the period of 9 years. Eleven girls presented with breast development, six with vaginal bleeding and seventeen with signs of puberty. On the basis of clinical signs, bone age, estradiol levels and LHRH test, premature thelarche was diagnosed in eleven patients (32.4%), premature menarche in six (17.6%) and central precocious puberty in ten girls (29.4%). Seven girls (20.6%) presented with pseudoprecocious puberty. Pelvic ultrasound examination revealed unilateral ovarian cysts in six patients and granulosa cell tumor in one. Elevated estrogen serum levels and failure of gonadotropin responses after gonadotropin releasing hormone were the classical findings in patients with isosexual pseudoprecocious puberty during the acute period of disease. In four patients, the cyst decreased spontaneously after several months, while in two patients, the cyst was removed by laparotomy. Surgical treatment was performed in a patient with granulosa cell tumor. CONCLUSION: Our work demonstrates that autonomous functional ovarian follicle cyst is the most often cause of isosexual pseudoprecocious puberty. Short period of observation is suggested because the cyst can resolve spontaneously. On the other hand, juvenile granulosa cell tumor, as highly malignant tumor, should be removed as soon as diagnosis is established.

[Attitudes of women and gynecologists towards voluntary sterilization in Serbia?].

INTRODUCTION: Voluntary sterilization is a very effective and safe birth control method. Is it, however, accepted as a birth control method in Serbia? This is certainly a question that should be explored, regardless of the fact that voluntary sterilization is neither accessible nor promoted. MATERIAL AND METHODS: The target group included women who decided to terminate their pregnancy, and gynecologists from various parts of Serbia. RESULTS AND DISCUSSION: The survey results indicate that more than half of women believe that voluntary sterilization should be available in Serbia. Also, a large number of surveyed women, almost half of them, would undergo voluntary sterilization. Younger women, respondents with secondary education, those who gave birth to a desired number of children, as well as those who have a good relationship with their partners, those who have experienced a great number of induced abortions, namely those who wish to use contraception in the future, are more open to voluntary sterilization. The majority of gynecologists also think that voluntary sterilization should become available in Serbia. Most of them consider therapeutic and eugenic reasons as appropriate for surgical sterilization. However, gynecologists lack current knowledge about this contraceptive method, and would not accept to use voluntary sterilization themselves. CONCLUSION: The reasons for individual nonacceptance indicate that many of the registered ambivalent or negative opinions can be changed by spreading knowledge on voluntary sterilization. Moreover, the knowledge of gynecologists about voluntary sterilization should be improved as well.

Rapidly growing bilateral ovarian cystadenoma in a 6-year-old girl: case report and literature review.

BACKGROUND: Benign ovarian neoplasms originating from epithelial tissue are common tumors in adult women. However, they are rarely seen in the pediatric population, especially in the first decade of life. CASE: We report a case of a 6-year-old, premenarchal girl, previously healthy, with frequent micturition lasting 3 days prior to the first examination, without discomfort or pain. Laboratory analyses of blood and urine showed no abnormalities. Repeated ultrasonographic examinations revealed bilateral, cystic, rapidly growing ovarian masses. Cysts were surgically removed, with preservation of normal ovarian tissue, and histopathologic findings showed a serous cystadenoma of both ovaries.

Attitudes to voluntary sterilization in Serbia: women's and gynecologists' points of view.

OBJECTIVES: The question if voluntary sterilization is accepted in Serbia has been imposed for research, regardless of the fact that this birth control method is neither accessible nor promoted. METHODS: The attitudes of women who decided to terminate pregnancy and of gynecologists from various parts of Serbia were explored by specially designed anonymous questionnaires. RESULTS: More than half of the surveyed women believe that voluntary sterilization should be available in Serbia and almost half would subject themselves to this surgical procedure. Younger women, respondents with secondary education, those who have the desired number of children, as well as those who have a good relationship with partner, who have experienced a large number of abortions, namely those who wish to use contraception, are more open to voluntary sterilization. The majority of gynecologists think that voluntary sterilization should become available in Serbia. Medical and eugenic reasons are, according to their opinion, the main indications for sterilization. The gynecologists lack current knowledge about this contraceptive method, and would not accept to use voluntary sterilization themselves. CONCLUSIONS: There is a need for voluntary sterilization as a contraceptive choice in Serbia. Relevant knowledge of women as well as gynecologists about voluntary sterilization should be improved.